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.     

Bayesian optimal phase II designs with dual-criterion decision making

The conventional phase II trial design paradigm is to make the go/no-go decision based on the hypothesis testing framework. Statistical significance itself alone, however, may not be sufficient to establish that the drug is clinically effective enough to warrant confirmatory phase III trials. We propose the Bayesian optimal phase II trial design with dual-criterion decision making (BOP2-DC), which incorporates both statistical significance and clinical relevance into decision making. Based on the posterior probability that the treatment effect reaches the lower reference value (statistical significance) and the clinically meaningful value (clinical significance), BOP2-DC allows for go/consider/no-go decisions, rather than a binary go/no-go decision. BOP2-DC is highly flexible and accommodates various types of endpoints, including binary, continuous, time-to-event, multiple, and coprimary endpoints, in single-arm and randomized trials. The decision rule of BOP2-DC is optimized to maximize the probability of a go decision when the treatment is effective or minimize the expected sample size when the treatment is futile. Simulation studies show that the BOP2-DC design yields desirable operating characteristics. The software to implement BOP2-DC is freely available at www.trialdesign.org .     

A Bayesian optimal interval design for dose optimization with a randomization scheme based on pharmacokinetics outcomes in oncology

The primary objective of an oncology dose-finding trial for novel therapies, such as molecularly targeted agents and immune-oncology therapies, is to identify the optimal dose (OD) that is tolerable and therapeutically beneficial for subjects in subsequent clinical trials. Pharmacokinetic (PK) information is considered an appropriate indicator for evaluating the level of drug intervention in humans from a pharmacological perspective. Several novel anticancer agents have been shown to have significant exposure-efficacy relationships, and some PK information has been considered an important predictor of efficacy. This paper proposes a Bayesian optimal interval design for dose optimization with a randomization scheme based on PK outcomes in oncology. A simulation study shows that the proposed design has advantages compared to the other designs in the percentage of correct OD selection and the average number of patients allocated to OD in various realistic settings.     

Response-adaptive trial designs with accelerated Thompson sampling

In a clinical trial, sometimes it is desirable to allocate as many patients as possible to the best treatment, in particular, when a trial for a rare disease may contain a considerable portion of the whole target population. The Gittins index rule is a powerful tool for sequentially allocating patients to the best treatment based on the responses of patients already treated. However, its application in clinical trials is limited due to technical complexity and lack of randomness. Thompson sampling is an appealing approach, since it makes a compromise between optimal treatment allocation and randomness with some desirable optimal properties in the machine learning context. However, in clinical trial settings, multiple simulation studies have shown disappointing results with Thompson samplers. We consider how to improve short-run performance of Thompson sampling and propose a novel acceleration approach. This approach can also be applied to situations when patients can only be allocated by batch and is very easy to implement without using complex algorithms. A simulation study showed that this approach could improve the performance of Thompson sampling in terms of average total response rate. An application to a redesign of a preference trial to maximize patient's satisfaction is also presented.     

Characterization of dose‐response for count data using a generalized MCP‐Mod approach in an adaptive dose‐ranging trial

Understanding the dose–response relationship is a key objective in Phase II clinical development. Yet, designing a dose‐ranging trial is a challenging task, as it requires identifying the therapeutic window and the shape of the dose–response curve for a new drug on the basis of a limited number of doses. Adaptive designs have been proposed as a solution to improve both quality and efficiency of Phase II trials as they give the possibility to select the dose to be tested as the trial goes. In this article, we present a ‘shapebased’ two‐stage adaptive trial design where the doses to be tested in the second stage are determined based on the correlation observed between efficacy of the doses tested in the first stage and a set of pre‐specified candidate dose–response profiles. At the end of the trial, the data are analyzed using the generalized MCP‐Mod approach in order to account for model uncertainty. A simulation study shows that this approach gives more precise estimates of a desired target dose (e.g. ED70) than a single‐stage (fixed‐dose) design and performs as well as a two‐stage D‐optimal design. We present the results of an adaptive model‐based dose‐ranging trial in multiple sclerosis that motivated this research and was conducted using the presented methodology. Copyright © 2015 John Wiley & Sons, Ltd.     

Seven useful designs

When designing a clinical trial there is a need to design a study that achieves the objectives of a trial both efficiently and with minimum resources. This paper describes seven trial designs that could possibly be used in clinical development and highlights how a design although not optimal for an individual study may be optimal for a wider clinical program.     

Bayesian optimal design for changepoint problems

We investigate Bayesian optimal designs for changepoint problems. We find robust optimal designs which allow for arbitrary distributions before and after the change, arbitrary prior densities on the parameters before and after the change, and any log‐concave prior density on the changepoint. We define a new design measure for Bayesian optimal design problems as a means of finding the optimal design. Our results apply to any design criterion function concave in the design measure. We illustrate our results by finding the optimal design in a problem motivated by a previous clinical trial. The Canadian Journal of Statistics 37: 495–513; 2009 © 2009 Statistical Society of Canada     

A signature enrichment design with Bayesian adaptive randomization

Clinical trials in the era of precision cancer medicine aim to identify and validate biomarker signatures which can guide the assignment of individually optimal treatments to patients. In this article, we propose a group sequential randomized phase II design, which updates the biomarker signature as the trial goes on, utilizes enrichment strategies for patient selection, and uses Bayesian response-adaptive randomization for treatment assignment. To evaluate the performance of the new design, in addition to the commonly considered criteria of Type I error and power, we propose four new criteria measuring the benefits and losses for individuals both inside and outside of the clinical trial. Compared with designs with equal randomization, the proposed design gives trial participants a better chance to receive their personalized optimal treatments and thus results in a higher response rate on the trial. This design increases the chance to discover a successful new drug by an adaptive enrichment strategy, i.e. identification and selective enrollment of a subset of patients who are sensitive to the experimental therapies. Simulation studies demonstrate these advantages of the proposed design. It is illustrated by an example based on an actual clinical trial in non-small-cell lung cancer.     

On the problem of augmented fractional factorial designs

Let D be a saturated fractional factorial design of the general K₁ x K₂ ...x K_t factorial such that it consists of m distinct treatment combinations and it is capable of providing an unbiased estimator of a subvector of m factorial parameters under the assumption that the remaining k-m,t (k = H it ) factorial parameters are negligible. Such a design will not provide an unbiased estimator of the varianceσ² Suppose that D is an optimal design with respect to some optimality criterion (e.g. d-optimality, a-optimality or e-optimality) and it is desirable to augment D with c treatmentcombinations with the aim to estimate ² Suppose that D is an optimal design with respect to some optimality criterion (e.g. d-optimality, a-optimality or e-optimality) and it is desirable to augment D with c treatment combinations with the aim to estimate σ² unbiasedly. The problem then is how to select the c treatment combinations such that the augmented design D retains its optimality property. This problem, in all its generality is extremely complex. The objective of this paper is to provide some insight in the problem by providing a partial answer in the case of the 2^tfactorial, using the d-optimality criterion.     

Optimal design of clinical trials comparing several treatments with a control

Clinical trials are often designed to compare several treatments with a common control arm in pairwise fashion. In this paper we study optimal designs for such studies, based on minimizing the total number of patients required to achieve a given level of power. A common approach when designing studies to compare several treatments with a control is to achieve the desired power for each individual pairwise treatment comparison. However, it is often more appropriate to characterize power in terms of the family of null hypotheses being tested, and to control the probability of rejecting all, or alternatively any, of these individual hypotheses. While all approaches lead to unbalanced designs with more patients allocated to the control arm, it is found that the optimal design and required number of patients can vary substantially depending on the chosen characterization of power. The methods make allowance for both continuous and binary outcomes and are illustrated with reference to two clinical trials, one involving multiple doses compared to placebo and the other involving combination therapy compared to mono-therapies. In one example a 55% reduction in sample size is achieved through an optimal design combined with the appropriate characterization of power.     

An introduction to designh optimality with an overview of the literature

A brief introduction to oprimal design theorv is given for those who are not familiar with the subject. A list of 312 selected articles on the theory of optimal design is provided. The bibliography should be sufficiently thorough to be of use to researchers in the field.     

Two-sample post-stratified or subgroup analysis with restricted randomization rules

In a clinical trial to compare two treatments, subjects may be allocated sequentially to treatment groups by a restricted randomization rule. Suppose that at the end of the trial, the investigator is interested in a post-stratified or subgroup analysis with respect to a particular demographic or clinical factor which was not selected prior to the trial for stratified randomization. Under a randomization model, large sample theory of two-sample post-stratified permutational tests is developed with a broad class of restricted randomization treatment allocation rules. The test procedures proposed here are illustrated with a real-life example. The results of this example indicate that it is not always possible to ignore the treatment rule used in the trial in the design-based analysis.     

Multiple-objective response-adaptive repeated measurement designs for clinical trials

In a response-adaptive design, we review and update the trial on the basis of outcomes in order to achieve a specific goal. Response-adaptive designs for clinical trials are usually constructed to achieve a single objective. In this paper, we develop a new adaptive allocation rule to improve current strategies for building response-adaptive designs to construct multiple-objective repeated measurement designs. This new rule is designed to increase estimation precision and treatment benefit by assigning more patients to a better treatment sequence. We demonstrate that designs constructed under the new proposed allocation rule can be nearly as efficient as fixed optimal designs in terms of the mean squared error, while leading to improved patient care.     

Response-adaptive randomization for survival trials: the parametric approach

Summary.  Few references deal with response-adaptive randomization procedures for survival outcomes and those that do either dichotomize the outcomes or use a non-parametric approach. In this paper, the optimal allocation approach and a parametric response-adaptive randomization procedure are used under exponential and Weibull distributions. The optimal allocation proportions are derived for both distributions and the doubly adaptive biased coin design is applied to target the optimal allocations. The asymptotic variance of the procedure is obtained for the exponential distribution. The effect of intrinsic delay of survival outcomes is treated. These findings are based on rigorous theory but are also verified by simulation. It is shown that using a doubly adaptive biased coin design to target the optimal allocation proportion results in more patients being randomized to the better performing treatment without loss of power. We illustrate our procedure by redesigning a clinical trial.     

A class of confidence intervals for sequential phase II clinical trials with binary outcome

The phase II clinical trials often use the binary outcome. Thus, accessing the success rate of the treatment is a primary objective for the phase II clinical trials. Reporting confidence intervals is a common practice for clinical trials. Due to the group sequence design and relatively small sample size, many existing confidence intervals for phase II trials are much conservative. In this paper, we propose a class of confidence intervals for binary outcomes. We also provide a general theory to assess the coverage of confidence intervals for discrete distributions, and hence make recommendations for choosing the parameter in calculating the confidence interval. The proposed method is applied to Simon's [14] optimal two-stage design with numerical studies. The proposed method can be viewed as an alternative approach for the confidence interval for discrete distributions in general.     

Optimal Partitioning for Linear Mixed Effects Models: Applications to Identifying Placebo Responders

A long-standing problem in clinical research is distinguishing drug treated subjects that respond due to specific effects of the drug from those that respond to non-specific (or placebo) effects of the treatment. Linear mixed effect models are commonly used to model longitudinal clinical trial data. In this paper we present a solution to the problem of identifying placebo responders using an optimal partitioning methodology for linear mixed effects models. Since individual outcomes in a longitudinal study correspond to curves, the optimal partitioning methodology produces a set of prototypical outcome profiles. The optimal partitioning methodology can accommodate both continuous and discrete covariates. The proposed partitioning strategy is compared and contrasted with the growth mixture modelling approach. The methodology is applied to a two-phase depression clinical trial where subjects in a first phase were treated openly for 12 weeks with fluoxetine followed by a double blind discontinuation phase where responders to treatment in the first phase were randomized to either stay on fluoxetine or switched to a placebo. The optimal partitioning methodology is applied to the first phase to identify prototypical outcome profiles. Using time to relapse in the second phase of the study, a survival analysis is performed on the partitioned data. The optimal partitioning results identify prototypical profiles that distinguish whether subjects relapse depending on whether or not they stay on the drug or are randomized to a placebo.     

Do single‐arm trials have a role in drug development plans incorporating randomised trials?

Often, single‐arm trials are used in phase II to gather the first evidence of an oncological drug's efficacy, with drug activity determined through tumour response using the RECIST criterion. Provided the null hypothesis of ‘insufficient drug activity’ is rejected, the next step could be a randomised two‐arm trial. However, single‐arm trials may provide a biased treatment effect because of patient selection, and thus, this development plan may not be an efficient use of resources. Therefore, we compare the performance of development plans consisting of single‐arm trials followed by randomised two‐arm trials with stand‐alone single‐stage or group sequential randomised two‐arm trials. Through this, we are able to investigate the utility of single‐arm trials and determine the most efficient drug development plans, setting our work in the context of a published single‐arm non‐small‐cell lung cancer trial. Reference priors, reflecting the opinions of ‘sceptical’ and ‘enthusiastic’ investigators, are used to quantify and guide the suitability of single‐arm trials in this setting. We observe that the explored development plans incorporating single‐arm trials are often non‐optimal. Moreover, even the most pessimistic reference priors have a considerable probability in favour of alternative plans. Analysis suggests expected sample size savings of up to 25% could have been made, and the issues associated with single‐arm trials avoided, for the non‐small‐cell lung cancer treatment through direct progression to a group sequential randomised two‐arm trial. Careful consideration should thus be given to the use of single‐arm trials in oncological drug development when a randomised trial will follow. Copyright © 2015 The Authors. Pharmaceutical Statistics published by JohnWiley & Sons Ltd.     

Optimal designs for estimating the slope of a regression

In the common linear model with quantitative predictors we consider the problem of designing experiments for estimating the slope of the expected response in a regression. We discuss locally optimal designs, where the experimenter is only interested in the slope at a particular point, and standardized minimax optimal designs, which could be used if precise estimation of the slope over a given region is required. General results on the number of support points of locally optimal designs are derived if the regression functions form a Chebyshev system. For polynomial regression and Fourier regression models of arbitrary degree the optimal designs for estimating the slope of the regression are determined explicitly for many cases of practical interest.     

Optimal Designs for the Carryover Model with Random Interactions Between Subjects and Treatments

The paper considers a model for crossover designs with carryover effects and a random interaction between treatments and subjects. Under this model, two observations of the same treatment on the same subject are positively correlated and therefore provide less information than two observations of the same treatment on different subjects. The introduction of the interaction makes the determination of optimal designs much harder than is the case for the traditional model. Generalising the results of Bludowsky's thesis, the present paper uses Kushner's method to determine optimal approximate designs. We restrict attention to the case where the number of periods is less than or equal to the number of treatments. We determine the optimal designs in the important special cases that the number of periods is 3, 4 or 5. It turns out that the optimal designs depend on the variance of the random interactions and in most cases are not binary. However, we can show that neighbour balanced binary designs are highly efficient, regardless of the number of periods and of the size of the variance of the interaction effects.