Arbuck S G
Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, USA.
Ann Oncol. 1996 Aug;7(6):567-73. doi: 10.1093/oxfordjournals.annonc.a010672.
Many of the methods currently used in phase I trial design date back to the 1970's. Recently, some investigators have considered whether it might be possible to perform more efficient phase I trials that minimize the number of patients treated at biologically ineffective doses, maximize the precision of recommended phase II doses, and maintain patient safety. The objective of this Workshop was to examine aspects of phase I trial design, with consideration of both standard and novel approaches. Topics included choice of starting dose level, definition of dose-limiting toxicity, development and incorporation of non-toxicity endpoints, use of alternate dose escalation schemes, and definitions of tumor response and clinical benefit, including consideration of whether these determinations from phase I studies should alter the decision to proceed to phase II drug evaluation. For each topic, this summary includes a description of the standard approach, a summary of the speaker's presentation, and commentary. The Workshop initiated discussion and reassessment that are expected to lead to testing of some of the suggested alternate approaches.
目前在I期试验设计中使用的许多方法可追溯到20世纪70年代。最近,一些研究人员考虑是否有可能进行更高效的I期试验,以尽量减少在生物学无效剂量下接受治疗的患者数量,最大限度地提高推荐的II期剂量的精确度,并确保患者安全。本次研讨会的目的是研究I期试验设计的各个方面,同时考虑标准方法和新方法。主题包括起始剂量水平的选择、剂量限制性毒性的定义、无毒终点的开发和纳入、替代剂量递增方案的使用,以及肿瘤反应和临床获益的定义,包括考虑I期研究中的这些判定是否应改变进入II期药物评估的决定。对于每个主题,本总结包括标准方法的描述、演讲者报告的总结以及评论。本次研讨会引发了讨论和重新评估,预计将导致对一些建议的替代方法进行测试。