Phase II trial design with growth modulation index as the primary endpoint

Molecularly targeted, genomic‐driven, and immunotherapy‐based clinical trials continue to be advanced for the treatment of relapse or refractory cancer patients, where the growth modulation index (GMI) is often considered a primary endpoint of treatment efficacy. However, there little literature is available that considers the trial design with GMI as the primary endpoint. In this article, we derived a sample size formula for the score test under a log‐linear model of the GMI. Study designs using the derived sample size formula are illustrated under a bivariate exponential model, the Weibull frailty model, and the generalized treatment effect size. The proposed designs provide sound statistical methods for a single‐arm phase II trial with GMI as the primary endpoint.     

Cancer immunotherapy trial design with delayed treatment effect

A challenge arising in cancer immunotherapy trial design is the presence of a delayed treatment effect wherein the proportional hazard assumption no longer holds true. As a result, a traditional survival trial design based on the standard log‐rank test, which ignores the delayed treatment effect, will lead to substantial loss of statistical power. Recently, a piecewise weighted log‐rank test is proposed to incorporate the delayed treatment effect into consideration of the trial design. However, because the sample size formula was derived under a sequence of local alternative hypotheses, it results in an underestimated sample size when the hazard ratio is relatively small for a balanced trial design and an inaccurate sample size estimation for an unbalanced design. In this article, we derived a new sample size formula under a fixed alternative hypothesis for the delayed treatment effect model. Simulation results show that the new formula provides accurate sample size estimation for both balanced and unbalanced designs.     

Sample size calculation for the one‐sample log‐rank test

In this paper, an exact variance of the one‐sample log‐rank test statistic is derived under the alternative hypothesis, and a sample size formula is proposed based on the derived exact variance. Simulation results showed that the proposed sample size formula provides adequate power to design a study to compare the survival of a single sample with that of a standard population. Copyright © 2014 John Wiley & Sons, Ltd.     

Sample Size Calculation and Blinded Sample Size Recalculation in Clinical Trials Where the Treatment Effect is Measured by the Relative Risk

In clinical trials with binary endpoints, the required sample size does not depend only on the specified type I error rate, the desired power and the treatment effect but also on the overall event rate which, however, is usually uncertain. The internal pilot study design has been proposed to overcome this difficulty. Here, nuisance parameters required for sample size calculation are re-estimated during the ongoing trial and the sample size is recalculated accordingly. We performed extensive simulation studies to investigate the characteristics of the internal pilot study design for two-group superiority trials where the treatment effect is captured by the relative risk. As the performance of the sample size recalculation procedure crucially depends on the accuracy of the applied sample size formula, we firstly explored the precision of three approximate sample size formulae proposed in the literature for this situation. It turned out that the unequal variance asymptotic normal formula outperforms the other two, especially in case of unbalanced sample size allocation. Using this formula for sample size recalculation in the internal pilot study design assures that the desired power is achieved even if the overall rate is mis-specified in the planning phase. The maximum inflation of the type I error rate observed for the internal pilot study design is small and lies below the maximum excess that occurred for the fixed sample size design.     

Sample size determination for testing equality in Poisson frequency data under an AB/BA crossover trial

Assuming that the frequency of occurrence follows the Poisson distribution, we develop sample size calculation procedures for testing equality based on an exact test procedure and an asymptotic test procedure under an AB/BA crossover design. We employ Monte Carlo simulation to demonstrate the use of these sample size formulae and evaluate the accuracy of sample size calculation formula derived from the asymptotic test procedure with respect to power in a variety of situations. We note that when both the relative treatment effect of interest and the underlying intraclass correlation between frequencies within patients are large, the sample size calculation based on the asymptotic test procedure can lose accuracy. In this case, the sample size calculation procedure based on the exact test is recommended. On the other hand, if the relative treatment effect of interest is small, the minimum required number of patients per group will be large, and the asymptotic test procedure will be valid for use. In this case, we may consider use of the sample size calculation formula derived from the asymptotic test procedure to reduce the number of patients needed for the exact test procedure. We include an example regarding a double‐blind randomized crossover trial comparing salmeterol with a placebo in exacerbations of asthma to illustrate the practical use of these sample size formulae. Copyright © 2013 John Wiley & Sons, Ltd.     

Sample size calculations for clinical studies allowing for uncertainty about the variance

One of the most important steps in the design of a pharmaceutical clinical trial is the estimation of the sample size. For a superiority trial the sample size formula (to achieve a stated power) would be based on a given clinically meaningful difference and a value for the population variance. The formula is typically used as though this population variance is known whereas in reality it is unknown and is replaced by an estimate with its associated uncertainty. The variance estimate would be derived from an earlier similarly designed study (or an overall estimate from several previous studies) and its precision would depend on its degrees of freedom. This paper provides a solution for the calculation of sample sizes that allows for the imprecision in the estimate of the sample variance and shows how traditional formulae give sample sizes that are too small since they do not allow for this uncertainty with the deficiency being more acute with fewer degrees of freedom. It is recommended that the methodology described in this paper should be used when the sample variance has less than 200 degrees of freedom.     

The Asymptotic Distribution of the S–Gini Index

Several generalizations of the classical Gini index, placing smaller or greater weights on various portions of income distribution, have been proposed by a number of authors. For purposes of statistical inference, the large sample distribution theory of the estimators of those measures of economic inequality is required. The present paper was stimulated by the use of bootstrap by Xu (2000) to estimate the variance of the estimator of the S –Gini index. It shows that the theory of L –statistics (Chernoff, Gastwirth & Johns, 1967; Shorack & Wellner, 1986) makes possible the construction of a consistent estimator for the S –Gini index and proof of its asymptotic normality. The paper also presents an explicit formula for the asymptotic variance. The formula should be helpful in planning the size of samples from which the S –Gini index can be estimated with a prescribed margin of error.     

Evaluation of statistical equivalence using limits of agreement and associated sample size calculation *

In this article, the Food and Drug Administration's (FDA) medical device substantial equivalence provision will be briefly introduced and some statistical methods useful for evaluating device equivalence are discussed. A sample size formula is derived for limits of agreement, which may be used to assess statistical equivalence in certain medical device situations. Simulation findings on the formula are presented, which can be used to guide sample size selections in common practical situations. Examples of the sample size procedure are given.     

A Note on Sample Size Determination for the Estimation of the Mean Vector of a Multivariate Population

In this article, we present a straightforward Bonferroni approach for determining sample size for estimating the mean vector of a multivariate population under two scenarios: (1) a pre-specified overall confidence level is desired; and (2) a pre-specified confidence level needs to be guaranteed for each individual variable. It is demonstrated that correlation between variables helps reduce the sample size. The formula to calculate the reduced sample size is derived. A binormal example is presented to illustrate the effect of correlation on sample size reduction for various values of the correlation coefficient.     

Sample size determinations when two binomial proportions are very small

Sample size determination for testing the hypothesis of equality of proportions with a specified type I and type I1 error probabilitiesis of ten based on normal approximation to the binomial distribution. When the proportionsinvolved are very small, the exact distribution of the test statistic may not follow the assumed distribution. Consequently, the sample size determined by the test statistic may not result in the sespecifiederror probabilities. In this paper the author proposes a square root formula and compares it with several existing sample size approximation methods. It is found that with small proportion (p≦.01) the squar eroot formula provides the closest approximation to the exact sample sizes which attain a specified type I and type II error probabilities. Thes quare root formula is simple inform and has the advantage that equal differencesare equally detectable.     

A convenient formula for sample size calculations in clinical trials with multiple co-primary continuous endpoints

The clinical efficacy of a new treatment may often be better evaluated by two or more co-primary endpoints. Recently, in pharmaceutical drug development, there has been increasing discussion regarding establishing statistically significant favorable results on more than one endpoint in comparisons between treatments, which is referred to as a problem of multiple co-primary endpoints. Several methods have been proposed for calculating the sample size required to design a trial with multiple co-primary correlated endpoints. However, because these methods require users to have considerable mathematical sophistication and knowledge of programming techniques, their application and spread may be restricted in practice. To improve the convenience of these methods, in this paper, we provide a useful formula with accompanying numerical tables for sample size calculations to design clinical trials with two treatments, where the efficacy of a new treatment is demonstrated on continuous co-primary endpoints. In addition, we provide some examples to illustrate the sample size calculations made using the formula. Using the formula and the tables, which can be read according to the patterns of correlations and effect size ratios expected in multiple co-primary endpoints, makes it convenient to evaluate the required sample size promptly.     

Asymptotic distributions of functions of a sample covariance matrix under the elliptical distribution

This paper is concerned with asymptotic distributions of functions of a sample covariance matrix under the elliptical model. Simple but useful formulae for calculating asymptotic variances and covariances of the functions are derived. Also, an asymptotic expansion formula for the expectation of a function of a sample covariance matrix is derived; it is given up to the second-order term with respect to the inverse of the sample size. Two examples are given: one of calculating the asymptotic variances and covariances of the stepdown multiple correlation coefficients, and the other of obtaining the asymptotic expansion formula for the moments of sample generalized variance.     

Power and sample size calculation for paired right-censored data based on survival copula models

Sample size determination is essential during the planning phases of clinical trials. To calculate the required sample size for paired right-censored data, the structure of the within-paired correlations needs to be pre-specified. In this article, we consider using popular parametric copula models, including the Clayton, Gumbel, or Frank families, to model the distribution of joint survival times. Under each copula model, we derive a sample size formula based on the testing framework for rank-based tests and non-rank-based tests (i.e., logrank test and Kaplan–Meier statistic, respectively). We also investigate how the power or the sample size was affected by the choice of testing methods and copula model under different alternative hypotheses. In addition to this, we examine the impacts of paired-correlations, accrual times, follow-up times, and the loss to follow-up rates on sample size estimation. Finally, two real-world studies are used to illustrate our method and R code is available to the user.     

Sample size determination for p-charts

Two types of decision errors can be made when using a quality control chart for non-conforming units (p-chart). A Type I error occurs when the process is not out of control but a search for an assignable cause is performed unnecessarily. A Type II error occurs when the process is out of control but a search for an assignable cause is not performed. The probability of a Type I error is under direct control of the decision-maker while the probability of a Type II error depends, in part, on the sample size. A simple sample size formula is presented for determining the required sample size for a p-chart with specified probabilities of Type I and Type II errors.     

Sample size calculation based on risk ratio under multiple matching

To increase the efficiency of comparisons between treatments in clinical trials, we may consider the use of a multiple matching design, in which, for each patient receiving the experimental treatment, we match with more than one patient receiving the standard treatment. To assess the efficacy of the experimental treatment, the risk ratio (RR) of patient responses between two treatments is certainly one of the most commonly used measures. Because the probability of patient responses in clinical trial is often not small, the odds ratio (OR), of which the practical interpretation is not easily understood, cannot approximate RR well. Thus, all sample size formulae in terms of OR for case-control studies with multiple matched controls per case can be of limited use here. In this paper, we develop three sample size formulae based on RR for randomized trials with multiple matching. We propose a test statistic for testing the equality of RR under multiple matching. On the basis of Monte Carlo simulation, we evaluate the performance of the proposed test statistic with respect to Type I error. To evaluate the accuracy and usefulness of the three sample size formulae developed in this paper, we further calculate their simulated powers and compare them with those of the sample size formula ignoring matching and the sample size formula based on OR for multiple matching published elsewhere. Finally, we include an example that employs the multiple matching study design about the use of the supplemental ascorbate in the supportive treatment of terminal cancer patients to illustrate the use of these formulae.     

Sample size estimation for a two-group comparison of repeated count outcomes using GEE

Randomized clinical trials with count measurements as the primary outcome are common in various medical areas such as seizure counts in epilepsy trials, or relapse counts in multiple sclerosis trials. Controlled clinical trials frequently use a conventional parallel-group design that assigns subjects randomly to one of two treatment groups and repeatedly evaluates them at baseline and intervals across a treatment period of a fixed duration. The primary interest is to compare the rates of change between treatment groups. Generalized estimating equations (GEEs) have been widely used to compare rates of change between treatment groups because of its robustness to misspecification of the true correlation structure. In this paper, we derive a sample size formula for comparing the rates of change between two groups in a repeatedly measured count outcome using GEE. The sample size formula incorporates general missing patterns such as independent missing and monotone missing, and general correlation structures such as AR(1) and compound symmetry (CS). The performance of the sample size formula is evaluated through simulation studies. Sample size estimation is illustrated by a clinical trial example from epilepsy.     

Development of Adaptive Group Sequential Procedure for Changing Sample Size

In this study, we propose a group sequential procedure that allows the change of necessary sample size at intermediary stage in sequential test. In the procedure, we formulate the conditional power to judge the necessity of the change of sample size in decision rules. Furthermore, we present an integral formula of the power of the test and show how to change the necessary sample size by using the power of the test. In simulation studies, we investigate the characteristics of the change of sample size and the pattern of decision across all stages based on generated normal random numbers.     

Effects of correlation and missing data on sample size estimation in longitudinal clinical trials

In longitudinal clinical trials, a common objective is to compare the rates of changes in an outcome variable between two treatment groups. Generalized estimating equation (GEE) has been widely used to examine if the rates of changes are significantly different between treatment groups due to its robustness to misspecification of the true correlation structure and randomly missing data. The sample size formula for repeated outcomes is based on the assumption of missing completely at random and a large sample approximation. A simulation study is conducted to investigate the performance of GEE sample size formula with small sample sizes, damped exponential family of correlation structure and non‐ignorable missing data. Copyright © 2008 John Wiley & Sons, Ltd.     

Single‐arm phase II trial design under parametric cure models

The current practice of designing single‐arm phase II survival trials is limited under the exponential model. Trial design under the exponential model may not be appropriate when a portion of patients are cured. There is no literature available for designing single‐arm phase II trials under the parametric cure model. In this paper, a test statistic is proposed, and a sample size formula is derived for designing single‐arm phase II trials under a class of parametric cure models. Extensive simulations showed that the proposed test and sample size formula perform very well under different scenarios. Copyright © 2015 John Wiley & Sons, Ltd.