Flexible Bayesian methods for cancer phase I clinical trials. Dose escalation with overdose control

2005 ◽  
Vol 24 (14) ◽  
pp. 2183-2196 ◽  
Author(s):  
Mourad Tighiouart ◽  
André Rogatko ◽  
James S. Babb
Keyword(s):  
Clinical Trials ◽  
Phase I ◽  
Bayesian Methods ◽  
Dose Escalation ◽  
Phase I Clinical Trials

scholarly journals Adaptive Dose-Finding Studies: A Review of Model-Guided Phase I Clinical Trials

2014 ◽  
Vol 32 (23) ◽  
pp. 2505-2511 ◽  
Author(s):  
Alexia Iasonos ◽  
John O'Quigley
Keyword(s):  
Clinical Trials ◽  
Phase I ◽  
Dose Escalation ◽  
Late Onset ◽  
Maximum Tolerated Dose ◽  
Dose Finding ◽  
Design Parameters ◽  
Phase I Trials ◽  
Phase I Clinical Trials ◽  
Trial Duration

Purpose We provide a comprehensive review of adaptive phase I clinical trials in oncology that used a statistical model to guide dose escalation to identify the maximum-tolerated dose (MTD). We describe the clinical setting, practical implications, and safety of such applications, with the aim of understanding how these designs work in practice. Methods We identified 53 phase I trials published between January 2003 and September 2013 that used the continual reassessment method (CRM), CRM using escalation with overdose control, or time-to-event CRM for late-onset toxicities. Study characteristics, design parameters, dose-limiting toxicity (DLT) definition, DLT rate, patient-dose allocation, overdose, underdose, sample size, and trial duration were abstracted from each study. In addition, we examined all studies in terms of safety, and we outlined the reasons why escalations occur and under what circumstances. Results On average, trials accrued 25 to 35 patients over a 2-year period and tested five dose levels. The average DLT rate was 18%, which is lower than in previous reports, whereas all levels above the MTD had an average DLT rate of 36%. On average, 39% of patients were treated at the MTD, and 74% were treated at either the MTD or an adjacent level (one level above or below). Conclusion This review of completed phase I studies confirms the safety and generalizability of model-guided, adaptive dose-escalation designs, and it provides an approach for using, interpreting, and understanding such designs to guide dose escalation in phase I trials.

scholarly journals Number of Patients per Cohort and Sample Size Considerations Using Dose Escalation with Overdose Control

2012 ◽  
Vol 2012 ◽  
pp. 1-16 ◽  
Author(s):  
Mourad Tighiouart ◽  
André Rogatko
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Phase I ◽  
Sample Size ◽  
Dose Escalation ◽  
Experimental Treatment ◽  
Maximum Tolerated Dose ◽  
Phase I Clinical Trials ◽  
Number Of Patients ◽  
Therapeutic Doses

The main objective of cancer phase I clinical trials is to determine a maximum tolerated dose (MTD) of a new experimental treatment. In practice, most of these trials are designed so that three patients per cohort are treated at the same dose level. In this paper, we compare the safety and efficiency of trials using the escalation with overdose control (EWOC) scheme designed with three or only one patient per cohort. We show through simulations that the number of patients per cohort does not impact the proportion of patients given therapeutic doses, safety of the trial, and efficiency of the estimate of the MTD. Additionally, we present guidelines and tabulated values on the number of patients needed to design a phase I cancer clinical trial using EWOC to achieve a given accuracy of the estimate of the MTD.

Bayesian methods for phase I clinical trials

1992 ◽  
Vol 11 (10) ◽  
pp. 1377-1389 ◽  
Author(s):  
Constantine Gatsonis ◽  
Joel B. Greenhouse
Keyword(s):  
Clinical Trials ◽  
Phase I ◽  
Bayesian Methods ◽  
Phase I Clinical Trials

scholarly journals Optimal biological dose: a systematic review in cancer phase I clinical trials

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Fraisse ◽  
D. Dinart ◽  
D. Tosi ◽  
C. Bellera ◽  
C. Mollevi
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Phase I ◽  
Dose Escalation ◽  
Phase 1 ◽  
Dose Finding ◽  
Cancer Clinical Trials ◽  
Phase I Clinical Trials ◽  
Cancer Trial ◽  
Biological Dose

Abstract Background Classical phase 1 dose-finding designs based on a single toxicity endpoint to assess the maximum tolerated dose were initially developed in the context of cytotoxic drugs. With the emergence of molecular targeted agents and immunotherapies, the concept of optimal biological dose (OBD) was subsequently introduced to account for efficacy in addition to toxicity. The objective was therefore to provide an overview of published phase 1 cancer clinical trials relying on the concept of OBD. Methods We performed a systematic review through a computerized search of the MEDLINE database to identify early phase cancer clinical trials that relied on OBD. Relevant publications were selected based on a two-step process by two independent readers. Relevant information (phase, type of therapeutic agents, objectives, endpoints and dose-finding design) were collected. Results We retrieved 37 articles. OBD was clearly mentioned as a trial objective (primary or secondary) for 22 articles and was traditionally defined as the smallest dose maximizing an efficacy criterion such as biological target: biological response, immune cells count for immunotherapies, or biological cell count for targeted therapies. Most trials considered a binary toxicity endpoint defined in terms of the proportion of patients who experienced a dose-limiting toxicity. Only two articles relied on an adaptive dose escalation design. Conclusions In practice, OBD should be a primary objective for the assessment of the recommended phase 2 dose (RP2D) for a targeted therapy or immunotherapy phase I cancer trial. Dose escalation designs have to be adapted accordingly to account for both efficacy and toxicity.

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