Bayesian nonparametric estimation of targeted agent effects on biomarker change to predict clinical outcome

A Causal Framework for Making Individualized Treatment Decisions in Oncology

Simple Summary

Physicians routinely make individualized treatment decisions by accounting for the joint effects of patient prognostic covariates and treatments on clinical outcomes. Ideally, this is performed using historical randomized clinical trial (RCT) data. Randomization ensures that unbiased estimates of causal treatment effect parameters can be obtained from the historical RCT data and used to predict each new patient’s outcome based on the joint effect of their baseline covariates and each treatment being considered. However, this process becomes problematic if a patient seen in the clinic is very different from the patients who were enrolled in the RCT. That is, if a new patient does not satisfy the entry criteria of the RCT, then the patient does not belong to the population represented by the patients who were studied in the RCT. In such settings, it still may be possible to utilize the RCT data to help choose a new patient’s treatment. This may be achieved by combining the RCT data with data from other clinical trials, or possibly preclinical experiments, and using the combined dataset to predict the patient’s expected outcome for each treatment being considered. In such settings, combining data from multiple sources in a way that is statistically reliable is not entirely straightforward, and correctly identifying and estimating the effects of treatments and patient covariates on clinical outcomes can be complex. Causal diagrams provide a rational basis to guide this process. The first step is to construct a causal diagram that reflects the plausible relationships between treatment variables, patient covariates, and clinical outcomes. If the diagram is correct, it can be used to determine what additional data may be needed, how to combine data from multiple sources, how to formulate a statistical model for clinical outcomes as a function of treatment and covariates, and how to compute an unbiased treatment effect estimate for each new patient. We use adjuvant therapy of renal cell carcinoma to illustrate how causal diagrams may be used to guide these steps.

Abstract

We discuss how causal diagrams can be used by clinicians to make better individualized treatment decisions. Causal diagrams can distinguish between settings where clinical decisions can rely on a conventional additive regression model fit to data from a historical randomized clinical trial (RCT) to estimate treatment effects and settings where a different approach is needed. This may be because a new patient does not meet the RCT’s entry criteria, or a treatment’s effect is modified by biomarkers or other variables that act as mediators between treatment and outcome. In some settings, the problem can be addressed simply by including treatment–covariate interaction terms in the statistical regression model used to analyze the RCT dataset. However, if the RCT entry criteria exclude a new patient seen in the clinic, it may be necessary to combine the RCT data with external data from other RCTs, single-arm trials, or preclinical experiments evaluating biological treatment effects. For example, external data may show that treatment effects differ between histological subgroups not recorded in an RCT. A causal diagram may be used to decide whether external observational or experimental data should be obtained and combined with RCT data to compute statistical estimates for making individualized treatment decisions. We use adjuvant treatment of renal cell carcinoma as our motivating example to illustrate how to construct causal diagrams and apply them to guide clinical decisions.

A Common Atoms Model for the Bayesian Nonparametric Analysis of Nested Data

The use of large datasets for targeted therapeutic interventions requires new ways to characterize the heterogeneity observed across subgroups of a specific population. In particular, models for partially exchangeable data are needed for inference on nested datasets, where the observations are assumed to be organized in different units and some sharing of information is required to learn distinctive features of the units. In this manuscript, we propose a nested common atoms model (CAM) that is particularly suited for the analysis of nested datasets where the distributions of the units are expected to differ only over a small fraction of the observations sampled from each unit. The proposed CAM allows a two-layered clustering at the distributional and observational level and is amenable to scalable posterior inference through the use of a computationally efficient nested slice sampler algorithm. We further discuss how to extend the proposed modeling framework to handle discrete measurements, and we conduct posterior inference on a real microbiome dataset from a diet swap study to investigate how the alterations in intestinal microbiota composition are associated with different eating habits. We further investigate the performance of our model in capturing true distributional structures in the population by means of a simulation study.

Bayesian nonparametric statistics: A new toolkit for discovery in cancer research

Many commonly used statistical methods for data analysis or clinical trial design rely on incorrect assumptions or assume an over-simplified framework that ignores important information. Such statistical practices may lead to incorrect conclusions about treatment effects or clinical trial designs that are impractical or that do not accurately reflect the investigator's goals. Bayesian nonparametric (BNP) models and methods are a very flexible new class of statistical tools that can overcome such limitations. This is because BNP models can accurately approximate any distribution or function and can accommodate a broad range of statistical problems, including density estimation, regression, survival analysis, graphical modeling, neural networks, classification, clustering, population models, forecasting and prediction, spatiotemporal models, and causal inference. This paper describes 3 illustrative applications of BNP methods, including a randomized clinical trial to compare treatments for intraoperative air leaks after pulmonary resection, estimating survival time with different multi-stage chemotherapy regimes for acute leukemia, and evaluating joint effects of targeted treatment and an intermediate biological outcome on progression-free survival time in prostate cancer.

Clustering distributions with the marginalized nested Dirichlet process

We introduce a marginal version of the nested Dirichlet process to cluster distributions or histograms. We apply the model to cluster genes by patterns of gene-gene interaction. The proposed approach is based on the nested partition that is implied in the original construction of the nested Dirichlet process. It allows simulation exact inference, as opposed to a truncated Dirichlet process approximation. More importantly, the construction highlights the nature of the nested Dirichlet process as a nested partition of experimental units. We apply the proposed model to inference on clustering genes related to DNA mismatch repair (DMR) by the distribution of gene-gene interactions with other genes. Gene-gene interactions are recorded as coefficients in an auto-logistic model for the co-expression of two genes, adjusting for copy number variation, methylation and protein activation. These coefficients are extracted from an online database, called Zodiac, computed based on The Cancer Genome Atlas (TCGA) data. We compare results with a variation of k-means clustering that is set up to cluster distributions, truncated NDP and a hierarchical clustering method. The proposed inference shows favorable performance, under simulated conditions and also in the real data sets.