TITE‐BOIN‐ET: Time‐to‐event Bayesian optimal interval design to accelerate dose‐finding based on both efficacy and toxicity outcomes

One of the primary purposes of an oncology dose‐finding trial is to identify an optimal dose (OD) that is both tolerable and has an indication of therapeutic benefit for subjects in subsequent clinical trials. In addition, it is quite important to accelerate early stage trials to shorten the entire period of drug development. However, it is often challenging to make adaptive decisions of dose escalation and de‐escalation in a timely manner because of the fast accrual rate, the difference of outcome evaluation periods for efficacy and toxicity and the late‐onset outcomes. To solve these issues, we propose the time‐to‐event Bayesian optimal interval design to accelerate dose‐finding based on cumulative and pending data of both efficacy and toxicity. The new design, named “TITE‐BOIN‐ET” design, is nonparametric and a model‐assisted design. Thus, it is robust, much simpler, and easier to implement in actual oncology dose‐finding trials compared with the model‐based approaches. These characteristics are quite useful from a practical point of view. A simulation study shows that the TITE‐BOIN‐ET design has advantages compared with the model‐based approaches in both the percentage of correct OD selection and the average number of patients allocated to the ODs across a variety of realistic settings. In addition, the TITE‐BOIN‐ET design significantly shortens the trial duration compared with the designs without sequential enrollment and therefore has the potential to accelerate early stage dose‐finding trials.     

Model Selection and Estimation with Quantal‐Response Data in Benchmark Risk Assessment

This article describes several approaches for estimating the benchmark dose (BMD) in a risk assessment study with quantal dose‐response data and when there are competing model classes for the dose‐response function. Strategies involving a two‐step approach, a model‐averaging approach, a focused‐inference approach, and a nonparametric approach based on a PAVA‐based estimator of the dose‐response function are described and compared. Attention is raised to the perils involved in data “double‐dipping” and the need to adjust for the model‐selection stage in the estimation procedure. Simulation results are presented comparing the performance of five model selectors and eight BMD estimators. An illustration using a real quantal‐response data set from a carcinogenecity study is provided.     

Patient-specific dose finding in phase I clinical trials

This article proposes an extension of the continual reassessment method to determine the maximum tolerated dose (MTD) in the presence of patients' heterogeneity in phase I clinical trials. To start with a simple case, we consider the covariate as a binary variable representing two groups of patients. A logistic regression model is used to establish the dose–response relationship and the design is based on the Bayesian framework. Simulation studies for six plausible dose–response scenarios show that the proposed design is likely to determine the MTD more accurately than the design that does not take covariate into consideration.     

Demonstrating the Benefits of Predictive Bayesian Dose–Response Relationships Using Six Exposure Studies of Cryptosporidium parvum

A conventional dose–response function can be refitted as additional data become available. A predictive dose–response function in contrast does not require a curve-fitting step, only additional data and presents the unconditional probabilities of illness, reflecting the level of information it contains. In contrast, the predictive Bayesian dose–response function becomes progressively less conservative as more information is included. This investigation evaluated the potential for using predictive Bayesian methods to develop a dose–response for human infection that improves on existing models, to show how predictive Bayesian statistical methods can utilize additional data, and expand the Bayesian methods for a broad audience including those concerned about an oversimplification of dose–response curve use in quantitative microbial risk assessment (QMRA). This study used a dose–response relationship incorporating six separate data sets for Cryptosporidium parvum. A Pareto II distribution with known priors was applied to one of the six data sets to calibrate the model, while the others were used for subsequent updating. While epidemiological principles indicate that local variations, host susceptibility, and organism strain virulence may vary, the six data sets all appear to be well characterized using the Bayesian approach. The adaptable model was applied to an existing data set for Campylobacter jejuni for model validation purposes, which yielded results that demonstrate the ability to analyze a dose–response function with limited data using and update those relationships with new data. An analysis of the goodness of fit compared to the beta-Poisson methods also demonstrated correlation between the predictive Bayesian model and the data.     

SPIRIT: A seamless phase I/II randomized design for immunotherapy trials

Immunotherapy—treatments that enlist the immune system to battle tumors—has received widespread attention in cancer research. Due to its unique features and mechanisms for treating cancer, immunotherapy requires novel clinical trial designs. We propose a Bayesian seamless phase I/II randomized design for immunotherapy trials (SPIRIT) to find the optimal biological dose (OBD) defined in terms of the restricted mean survival time. We jointly model progression‐free survival and the immune response. Progression‐free survival is used as the primary endpoint to determine the OBD, and the immune response is used as an ancillary endpoint to quickly screen out futile doses. Toxicity is monitored throughout the trial. The design consists of two seamlessly connected stages. The first stage identifies a set of safe doses. The second stage adaptively randomizes patients to the safe doses identified and uses their progression‐free survival and immune response to find the OBD. The simulation study shows that the SPIRIT has desirable operating characteristics and outperforms the conventional design.     

Viewpoint: model selection uncertainty,pre‐specification,and model averaging

Scientific progress in all empirical sciences relies on selecting models and performing inferences from selected models. Standard statistical properties (e.g., repeated sampling coverage probability of confidence intervals) cannot be guaranteed after a model selection. This viewpoint reviews this dilemma, puts the role that pre‐specification can play into perspective and illustrates model averaging as a way to relax the problem of model selection uncertainty. Copyright © 2015 John Wiley & Sons, Ltd.     

A Probabilistic Approach for Deriving Acceptable Human Intake Limits and Human Health Risks from Toxicological Studies: General Framework

The use of uncertainty factors in the standard method for deriving acceptable intake or exposure limits for humans, such as the Reference Dose (RfD), may be viewed as a conservative method of taking various uncertainties into account. As an obvious alternative, the use of uncertainty distributions instead of uncertainty factors is gaining attention. This paper presents a comprehensive discussion of a general framework that quantifies both the uncertainties in the no-adverse-effect level in the animal (using a benchmark-like approach) and the uncertainties in the various extrapolation steps involved (using uncertainty distributions). This approach results in an uncertainty distribution for the no-adverse-effect level in the sensitive human subpopulation, reflecting the overall scientific uncertainty associated with that level. A lower percentile of this distribution may be regarded as an acceptable exposure limit (e.g., RfD) that takes account of the various uncertainties in a nonconservative fashion. The same methodology may also be used as a tool to derive a distribution for possible human health effects at a given exposure level. We argue that in a probabilistic approach the uncertainty in the estimated no-adverse-effect-level in the animal should be explicitly taken into account. Not only is this source of uncertainty too large to be ignored, it also has repercussions for the quantification of the other uncertainty distributions.     

Model Averaging Using Fractional Polynomials to Estimate a Safe Level of Exposure

Quantitative risk assessment involves the determination of a safe level of exposure. Recent techniques use the estimated dose-response curve to estimate such a safe dose level. Although such methods have attractive features, a low-dose extrapolation is highly dependent on the model choice. Fractional polynomials, basically being a set of (generalized) linear models, are a nice extension of classical polynomials, providing the necessary flexibility to estimate the dose-response curve. Typically, one selects the best-fitting model in this set of polynomials and proceeds as if no model selection were carried out. We show that model averaging using a set of fractional polynomials reduces bias and has better precision in estimating a safe level of exposure (say, the benchmark dose), as compared to an estimator from the selected best model. To estimate a lower limit of this benchmark dose, an approximation of the variance of the model-averaged estimator, as proposed by Burnham and Anderson, can be used. However, this is a conservative method, often resulting in unrealistically low safe doses. Therefore, a bootstrap-based method to more accurately estimate the variance of the model averaged parameter is proposed.     

公平责任的滥用与《民法典》侵权编的应对

我国《侵权责任法》第24条规定：行为人和受害人对损害的发生都没有过错的，可以根据实际情况，由双方分担损失。该条文以一般条款的形式赋予法官较大的自由裁量权，导致公平责任原则滥用，使公平责任不再公平。《民法典》第1186条对公平责任原则进行了修正，明确公平责任原则仅是行为人与受害人之间的损失分担规则，而非归责原则；采纳与大陆法系国家相同的特别规定的规范模式，将公平责任的适用仅限于法律规定的因自然因素引起的紧急避险、完全行为能力人无过错使自己陷入无意识或失去控制的状态致他人受损害、高空抛物无法查明侵权人时使用人的补偿三种情形，使得公平责任不再被滥用。