A note on confidence bounds after fixed-sequence multiple tests

We are concerned with the problem of estimating the treatment effects at the effective doses in a dose-finding study. Under monotone dose-response, the effective doses can be identified through the estimation of the minimum effective dose, for which there is an extensive set of statistical tools. In particular, when a fixed-sequence multiple testing procedure is used to estimate the minimum effective dose, Hsu and Berger (1999) show that the confidence lower bounds for the treatment effects can be constructed without the need to adjust for multiplicity. Their method, called the dose-response method, is simple to use, but does not account for the magnitude of the observed treatment effects. As a result, the dose-response method will estimate the treatment effects at effective doses with confidence bounds invariably identical to the hypothesized value. In this paper, we propose an error-splitting method as a variant of the dose-response method to construct confidence bounds at the identified effective doses after a fixed-sequence multiple testing procedure. Our proposed method has the virtue of simplicity as in the dose-response method, preserves the nominal coverage probability, and provides sharper bounds than the dose-response method in most cases.     

Robust williams trent test

To investigate the biological activities of a new compound or drug, experimenters usually compare a series of increasing doses to a control. Among other objectives, one may try to investigate any possible dose-response trend and to determine the minimum effective dose among all the experimental doses. Williams (1971, 1972) proposed a procedure to test the dose-response trend and also to identify the minimum effective dose based on the normally distributed data. In this paper, we propose a similar test procedure based on the robust estimate'of the average response to perform similar analysis. The proposed method is more resistant to the outliers and more powerful than the Williams procedure when the data distribution deviates from normality. We illustrate the use of this procedure with data arising from a recent study.     

Optimal designs for the development of personalized treatment rules

We study the design of multi-armed parallel group clinical trials to estimate personalized treatment rules that identify the best treatment for a given patient with given covariates. Assuming that the outcomes in each treatment arm are given by a homoscedastic linear model, with possibly different variances between treatment arms, and that the trial subjects form a random sample from an unselected overall population, we optimize the (possibly randomized) treatment allocation allowing the allocation rates to depend on the covariates. We find that, for the case of two treatments, the approximately optimal allocation rule does not depend on the value of the covariates but only on the variances of the responses. In contrast, for the case of three treatments or more, the optimal treatment allocation does depend on the values of the covariates as well as the true regression coefficients. The methods are illustrated with a recently published dietary clinical trial.     

Identification of the minimum effective dose based on weighted Kaplan–Meier statistics

Testing procedures are considered for identifying the minimum effective dose (MED) in a dose–response study with randomly right-censored survival data, where the MED is defined to be the smallest dose level under study that has survival advantage over the zero dose control. The proposed testing procedures are implemented in a step-down manner together with three different types of weighted Kaplan–Meier statistics. Comparative results of a Monte Carlo error rate and power/bias study for a variety of survival and censoring distributions are then presented and discussed. The application of the proposed procedures is finally illustrated for identifying the MED of the diethylstilbestrol in the treatment of prostate cancer.     

Dose finding when the target dose is on a plateau of a dose–response curve: comparison of fully sequential designs

Consider the problem of estimating a dose with a certain response rate. Many multistage dose‐finding designs for this problem were originally developed for oncology studies where the mean dose–response is strictly increasing in dose. In non‐oncology phase II dose‐finding studies, the dose–response curve often plateaus in the range of interest, and there are several doses with the mean response equal to the target. In this case, it is usually of interest to find the lowest of these doses because higher doses might have higher adverse event rates. It is often desirable to compare the response rate at the estimated target dose with a placebo and/or active control. We investigate which of the several known dose‐finding methods developed for oncology phase I trials is the most suitable when the dose–response curve plateaus. Some of the designs tend to spread the allocation among the doses on the plateau. Others, such as the continual reassessment method and the t‐statistic design, concentrate allocation at one of the doses with the t‐statistic design selecting the lowest dose on the plateau more frequently. Copyright © 2013 John Wiley & Sons, Ltd.     

Dose intra-subject escalation to an event (DIETE): A new method for phase 1 dose-finding utilizing systematic intra-subject dose escalation with application to T-cell engagers

T-cell engagers are a class of oncology drugs which engage T-cells to initiate immune response against malignant cells. T-cell engagers have features that are unlike prior classes of oncology drugs (e.g., chemotherapies or targeted therapies), because (1) starting dose level often must be conservative due to immune-related side effects such as cytokine release syndrome (CRS); (2) dose level can usually be safely titrated higher as a result of subject's immune system adaptation after first exposure to lower dose; and (3) due to preventive management of CRS, these safety events rarely worsen to become dose limiting toxicities (DLTs). It is generally believed that for T-cell engagers the dose intensity of the starting dose and the peak dose intensity both correlate with improved efficacy. Existing dose finding methodologies are not designed to efficiently identify both the initial starting dose and peak dose intensity in a single trial. In this study, we propose a new trial design, dose intra-subject escalation to an event (DIETE) design, that can (1) estimate the maximum tolerated initial dose level (MTD1); and (2) incorporate systematic intra-subject dose-escalation to estimate the maximum tolerated dose level subsequent to adaptation induced by the initial dose level (MTD2) with a survival analysis approach. We compare our framework to similar methodologies and evaluate their key operating characteristics.     

Power and sample size determination for a stepwise test procedure for finding the maximum safe dose

This paper addresses the problem of power and sample size calculation for a stepwise multiple test procedure (SD2PC) proposed in Tamhane et al. [2001. Multiple test procedures for identifying the maximum safe dose. J. Amer. Statist. Assoc. 96, 835–843] to identify the maximum safe dose of a compound. A general expression for the power of this procedure is derived. It is used to find the minimum overall power and minimum power under the constraint that the dose response function is bounded from below by a linear response function. It is shown that the two minima are attained under step and linear response functions, respectively. The sample sizes necessary on the zero dose control and each of the positive doses to guarantee a specified power requirement are calculated under these two least favorable configurations. A technique involving a continuous approximation to the sample sizes is used to reduce the number of quantities that need to be tabled, and to derive the asymptotically optimal allocation of the total sample size between the zero dose and the positive doses. An example is given to illustrate use of the tables. Extensions of the basic formulation are noted.     

AIDE: Adaptive intrapatient dose escalation designs to accelerate Phase I clinical trials

Designing Phase I clinical trials is challenging when accrual is slow or sample size is limited. The corresponding key question is: how to efficiently and reliably identify the maximum tolerated dose (MTD) using a sample size as small as possible? We propose model-assisted and model-based designs with adaptive intrapatient dose escalation (AIDE) to address this challenge. AIDE is adaptive in that the decision of conducting intrapatient dose escalation depends on both the patient's individual safety data, as well as other enrolled patient's safety data. When both data indicate reasonable safety, a patient may perform intrapatient dose escalation, generating toxicity data at more than one dose. This strategy not only provides patients the opportunity to receive higher potentially more effective doses, but also enables efficient statistical learning of the dose-toxicity profile of the treatment, which dramatically reduces the required sample size. Simulation studies show that the proposed designs are safe, robust, and efficient to identify the MTD with a sample size that is substantially smaller than conventional interpatient dose escalation designs. Practical considerations are provided and R code for implementing AIDE is available upon request.     

Bayesian adaptive dose‐escalation designs for simultaneously estimating the optimal and maximum safe dose based on safety and efficacy

The main purpose of dose‐escalation trials is to identify the dose(s) that is/are safe and efficacious for further investigations in later studies. In this paper, we introduce dose‐escalation designs that incorporate both the dose‐limiting events and dose‐limiting toxicities (DLTs) and indicative responses of efficacy into the procedure. A flexible nonparametric model is used for modelling the continuous efficacy responses while a logistic model is used for the binary DLTs. Escalation decisions are based on the combination of the probabilities of DLTs and expected efficacy through a gain function. On the basis of this setup, we then introduce 2 types of Bayesian adaptive dose‐escalation strategies. The first type of procedures, called “single objective,” aims to identify and recommend a single dose, either the maximum tolerated dose, the highest dose that is considered as safe, or the optimal dose, a safe dose that gives optimum benefit risk. The second type, called “dual objective,” aims to jointly estimate both the maximum tolerated dose and the optimal dose accurately. The recommended doses obtained under these dose‐escalation procedures provide information about the safety and efficacy profile of the novel drug to facilitate later studies. We evaluate different strategies via simulations based on an example constructed from a real trial on patients with type 2 diabetes, and the use of stopping rules is assessed. We find that the nonparametric model estimates the efficacy responses well for different underlying true shapes. The dual‐objective designs give better results in terms of identifying the 2 real target doses compared to the single‐objective designs.     

Inference on the Minimum Effective Dose Using Binary Data

This article proposes a confidence interval procedure for an open question posted by Tamhane and Dunnett regarding the inference on the minimum effective dose of a drug for binary data. We use a partitioning approach in conjunction with a confidence interval procedure to provide a solution to this problem. Binary data frequently arise in medical investigations in connection with dichotomous outcomes such as the development of a disease or the efficacy of a drug. The proposed procedure not only detects the minimum effective dose of the drug, but also provides estimation information on the treatment effect of the closest ineffective dose. Such information benefits follow-up investigations in clinical trials. We prove that, when the confidence interval for the pairwise comparison has (or asymptotically controls) confidence level 1 ? α, the stepwise procedure strongly controls (or asymptotically controls) the familywise error rate at level α, which is a key criterion in dose finding. The new method is compared with other procedures in terms of power performance and coverage probability using simulations. The simulated results shed new light on the discernible features of the new procedure. An example on the investigation of acetaminophen is included.     

Expected loss functions as additional measures to assess performance of multiple testing procedures for combination drug dose finding

There are several measures that are commonly used to assess performance of a multiple testing procedure (MTP). These measures include power, overall error rate (family‐wise error rate), and lack of power. In settings where the MTP is used to estimate a parameter, for example, the minimum effective dose, bias is of interest. In some studies, the parameter has a set‐like structure, and thus, bias is not well defined. Nevertheless, the accuracy of estimation is one of the essential features of an MTP in such a context. In this paper, we propose several measures based on the expected values of loss functions that resemble bias. These measures are constructed to be useful in combination drug dose response studies when the target is to identify all minimum efficacious drug combinations. One of the proposed measures allows for assigning different penalties for incorrectly overestimating and underestimating a true minimum efficacious combination. Several simple examples are considered to illustrate the proposed loss functions. Then, the expected values of these loss functions are used in a simulation study to identify the best procedure among several methods used to select the minimum efficacious combinations, where the measures take into account the investigator's preferences about possibly overestimating and/or underestimating a true minimum efficacious combination. The ideas presented in this paper can be generalized to construct measures that resemble bias in other settings. These measures can serve as an essential tool to assess performance of several methods for identifying set‐like parameters in terms of accuracy of estimation. Copyright © 2012 John Wiley & Sons, Ltd.     

Adaptive modelling of dose–response relationships using smoothing splines

We consider the use of smoothing splines for the adaptive modelling of dose–response relationships. A smoothing spline is a nonparametric estimator of a function that is a compromise between the fit to the data and the degree of smoothness and thus provides a flexible way of modelling dose–response data. In conjunction with decision rules for which doses to continue with after an interim analysis, it can be used to give an adaptive way of modelling the relationship between dose and response. We fit smoothing splines using the generalized cross‐validation criterion for deciding on the degree of smoothness and we use estimated bootstrap percentiles of the predicted values for each dose to decide upon which doses to continue with after an interim analysis. We compare this approach with a corresponding adaptive analysis of variance approach based upon new simulations of the scenarios previously used by the PhRMA Working Group on Adaptive Dose‐Ranging Studies. The results obtained for the adaptive modelling of dose–response data using smoothing splines are mostly comparable with those previously obtained by the PhRMA Working Group for the Bayesian Normal Dynamic Linear model (GADA) procedure. These methods may be useful for carrying out adaptations, detecting dose–response relationships and identifying clinically relevant doses. Copyright © 2009 John Wiley & Sons, Ltd.     

Performance of phase-I dose finding designs with and without a run-in intra-patient dose escalation stage

Dose-finding designs for phase-I trials aim to determine the recommended phase-II dose (RP2D) for further phase-II drug development. If the trial includes patients for whom several lines of standard therapy failed or if the toxicity of the investigated agent does not necessarily increase with dose, optimal dose-finding designs should limit the frequency of treatment with suboptimal doses. We propose a two-stage design strategy with a run-in intra-patient dose escalation part followed by a more traditional dose-finding design. We conduct simulation studies to compare the 3 + 3 design, the Bayesian Optimal Interval Design (BOIN) and the Continual Reassessment Method (CRM) with and without intra-patient dose escalation. The endpoints are accuracy, sample size, safety, and therapeutic efficiency. For scenarios where the correct RP2D is the highest dose, inclusion of an intra-patient dose escalation stage generally increases accuracy and therapeutic efficiency. However, for scenarios where the correct RP2D is below the highest dose, intra-patient dose escalation designs lead to increased risk of overdosing and an overestimation of RP2D. The magnitude of the change in operating characteristics after including an intra-patient stage is largest for the 3 + 3 design, decreases for the BOIN and is smallest for the CRM.     

A randomized phase I Bayesian dose escalation design for the combination of anti‐cancer drugs

Nowadays, treatment regimens for cancer often involve a combination of drugs. The determination of the doses of each of the combined drugs in phase I dose escalation studies poses methodological challenges. The most common phase I design, the classic ‘3+3' design, has been criticized for poorly estimating the maximum tolerated dose (MTD) and for treating too many subjects at doses below the MTD. In addition, the classic ‘3+3' is not able to address the challenges posed by combinations of drugs. Here, we assume that a control drug (commonly used and well‐studied) is administered at a fixed dose in combination with a new agent (the experimental drug) of which the appropriate dose has to be determined. We propose a randomized design in which subjects are assigned to the control or to the combination of the control and experimental. The MTD is determined using a model‐based Bayesian technique based on the difference of probability of dose limiting toxicities (DLT) between the control and the combination arm. We show, through a simulation study, that this approach provides better and more accurate estimates of the MTD. We argue that this approach may differentiate between an extreme high probability of DLT observed from the control and a high probability of DLT of the combination. We also report on a fictive (simulation) analysis based on published data of a phase I trial of ifosfamide combined with sunitinib.Copyright © 2014 John Wiley & Sons, Ltd.     

Cumulative cohort design for dose-finding

We introduce a new design for dose-finding in the context of toxicity studies for which it is assumed that toxicity increases with dose. The goal is to identify the maximum tolerated dose, which is taken to be the dose associated with a prespecified “target” toxicity rate. The decision to decrease, increase or repeat a dose for the next subject depends on how far an estimated toxicity rate at the current dose is from the target. The size of the window within which the current dose will be repeated is obtained based on the theory of Markov chains as applied to group up-and-down designs. But whereas the treatment allocation rule in Markovian group up-and-down designs is only based on information from the current cohort of subjects, the treatment allocation rule for the proposed design is based on the cumulative information at the current dose. We then consider an extension of this new design for clinical trials in which the subject's outcome is not known immediately. The new design is compared to the continual reassessment method.     

Incorporating historical information to improve dose optimization design with toxicity and efficacy endpoints: iBOIN-ET

In modern oncology drug development, adaptive designs have been proposed to identify the recommended phase 2 dose. The conventional dose finding designs focus on the identification of maximum tolerated dose (MTD). However, designs ignoring efficacy could put patients under risk by pushing to the MTD. Especially in immuno-oncology and cell therapy, the complex dose-toxicity and dose-efficacy relationships make such MTD driven designs more questionable. Additionally, it is not uncommon to have data available from other studies that target on similar mechanism of action and patient population. Due to the high variability from phase I trial, it is beneficial to borrow historical study information into the design when available. This will help to increase the model efficiency and accuracy and provide dose specific recommendation rules to avoid toxic dose level and increase the chance of patient allocation at potential efficacious dose levels. In this paper, we propose iBOIN-ET design that uses prior distribution extracted from historical studies to minimize the probability of decision error. The proposed design utilizes the concept of skeleton from both toxicity and efficacy data, coupled with prior effective sample size to control the amount of historical information to be incorporated. Extensive simulation studies across a variety of realistic settings are reported including a comparison of iBOIN-ET design to other model based and assisted approaches. The proposed novel design demonstrates the superior performances in percentage of selecting the correct optimal dose (OD), average number of patients allocated to the correct OD, and overdosing control during dose escalation process.     

On the multivariate predictive distribution of multi-dimensional effective dose: a Bayesian approach

We propose a Bayesian procedure to sample from the distribution of the multi-dimensional effective dose. This effective dose is the set of dose levels of multiple predictive factors that produce a binary response with a fixed probability.We apply our algorithms to parametric and semiparametric logistics regression models, respectively. The graphical display of random samples obtained through Markov chain Monte Carlo can provide some insight into the predictive distribution.     

Benchmark profile and inferences for joint-exposure quantal data in quantitative risk assessment

Abstract

In risk assessment, it is often desired to make inferences on the minimum dose levels (benchmark doses or BMDs) at which a specific benchmark risk (BMR) is attained. The estimation and inferences of BMDs are well understood in the case of an adverse response to a single-exposure agent. However, the theory of finding BMDs and making inferences on the BMDs is much less developed for cases where the adverse effect of two hazardous agents is studied simultaneously. Deutsch and Piegorsch [2012. Benchmark dose profiles for joint-action quantal data in quantitative risk assessment. Biometrics 68(4):1313–22] proposed a benchmark modeling paradigm in dual exposure setting—adapted from the single-exposure setting—and developed a strategy for conducting full benchmark analysis with joint-action quantal data, and they further extended the proposed benchmark paradigm to continuous response outcomes [Deutsch, R. C., and W. W. Piegorsch. 2013. Benchmark dose profiles for joint-action continuous data in quantitative risk assessment. Biometrical Journal 55(5):741–54]. In their 2012 article, Deutsch and Piegorsch worked exclusively with the complementary log link for modeling the risk with quantal data. The focus of the current paper is on the logit link; particularly, we consider an Abbott-adjusted [A method of computing the effectiveness of an insecticide. Journal of Economic Entomology 18(2):265–7] log-logistic model for the analysis of quantal data with nonzero background response. We discuss the estimation of the benchmark profile (BMP)—a collection of benchmark points which induce the prespecified BMR—and propose different methods for building benchmark inferences in studies involving two hazardous agents. We perform Monte Carlo simulation studies to evaluate the characteristics of the confidence limits. An example is given to illustrate the use of the proposed methods.     

Robust joint estimation of location and scale parameters in ranked set samples

A robust estimator is developed for the location and scale parameters of a location-scale family. The estimator is defined as the minimizer of a minimum distance function that measures the distance between the ranked set sample empirical cumulative distribution function and a possibly misspecified target model. We show that the estimator is asymptotically normal, robust, and has high efficiency with respect to its competitors in literature. It is also shown that the location estimator is consistent within the class of all symmetric distributions whereas the scale estimator is Fisher consistent at the true target model. The paper also considers an optimal allocation procedure that does not introduce any bias due to judgment error classification. It is shown that this allocation procedure is equivalent to Neyman allocation. A numerical efficiency comparison is provided.     

A maximin criterion for the logistic random intercept model with covariates

A maximin criterion is used to find optimal designs for the logistic random intercept model with dichotomous independent variables. The dichotomous independent variables can be subdivided into variables for which the distribution is specified prior to data sampling, called variates, and into variables for which the distribution is not specified prior to data sampling, but is obtained from data sampling, called covariates. The proposed maximin criterion maximizes the smallest possible relative efficiency not only with respect to all possible values of the model parameters, but also with respect to the joint distribution of the covariates. We have shown that, under certain conditions, the maximin design is balanced with respect to the joint distribution of the variates. The proposed method will be used to plan a (stratified) clinical trial where variates and covariates are involved.