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A product of independent beta probabilities dose escalation design for dual-agent phase I trials.


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Authors

Mander, Adrian P 
Sweeting, Michael J 

Abstract

Dual-agent trials are now increasingly common in oncology research, and many proposed dose-escalation designs are available in the statistical literature. Despite this, the translation from statistical design to practical application is slow, as has been highlighted in single-agent phase I trials, where a 3 + 3 rule-based design is often still used. To expedite this process, new dose-escalation designs need to be not only scientifically beneficial but also easy to understand and implement by clinicians. In this paper, we propose a curve-free (nonparametric) design for a dual-agent trial in which the model parameters are the probabilities of toxicity at each of the dose combinations. We show that it is relatively trivial for a clinician's prior beliefs or historical information to be incorporated in the model and updating is fast and computationally simple through the use of conjugate Bayesian inference. Monotonicity is ensured by considering only a set of monotonic contours for the distribution of the maximum tolerated contour, which defines the dose-escalation decision process. Varied experimentation around the contour is achievable, and multiple dose combinations can be recommended to take forward to phase II. Code for R, Stata and Excel are available for implementation.

Description

Keywords

adaptive design, dose escalation, dual-agent trial, nonparametric, phase I clinical trial, Antineoplastic Combined Chemotherapy Protocols, Clinical Trials, Phase I as Topic, Computer Simulation, Dose-Response Relationship, Drug, Humans, Logistic Models, Maximum Tolerated Dose, Research Design, Statistics, Nonparametric

Journal Title

Stat Med

Conference Name

Journal ISSN

0277-6715
1097-0258

Volume Title

34

Publisher

John Wiley and Sons Ltd
Sponsorship
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
We would like to acknowledge funding from the UK Medical Research Council (grant code U1052.00.014) for this work. We would also like to thank the reviewers for providing some excellent suggestions to help improve the manuscript.