Phase II study of TP300 in patients with advanced gastric or gastro-oesophageal junction adenocarcinoma

Inefficiency of two-stage designs in phase II oncology clinical trials with high proportion of inevaluable patients

BACKGROUND

Two-stage designs are commonly used for oncology Phase II clinical trials with a binary response endpoint. An issue that has not gained sufficient attention is the potential inefficiency in the usage of two-stage designs due to multiple enrollment suspensions when the proportion of patients inevaluable for response is high.

METHODS

Simulation studies were used to assess the performance of Simon's two-stage designs, two-stage designs with a proposed modification, and a single-stage design in the context of Phase II clinical trials with a high proportion of patients inevaluable for response.

RESULTS

Two-stage designs can require multiple enrollment disruptions when the inevaluable proportion is high, which can result in unacceptable inefficiency. The proposed modification provides a practical solution to this issue by enrolling an extra number of patients towards the end of the 1st stage, anticipating that a proportion of the patients pending response evaluation could be inevaluable. Single-stage designs with interim monitoring of futility that require no interim accrual suspension can be more efficient than two-stage designs, especially when the accrual and inevaluable rates are high.

CONCLUSIONS

Planning of Phase II trials should consider the issue of inefficiency of the two-stage designs, especially for trials with a high inevaluable proportion. Designs with monitoring rules that do not require accrual suspensions may be given more considerations, especially in trials of agents that have already had some evidence for safety and efficacy in other populations.

Recent Progress in the Development of Quinoline Derivatives for the Exploitation of Anti-Cancer Agents

BACKGROUND

Along with the progress in medicine and therapies, the exploitation of anti-cancer agents focused more on the vital signaling pathways and key biological macromolecules. With rational design and advanced synthesis, quinoline derivatives have been utilized frequently in medicinal chemistry, especially in developing anti-cancer drugs or candidates.

METHODS

Using DOI searching, articles published before 2020 all over the world have been reviewed as comprehensively as possible.

RESULTS

In this review, we selected the representative quinoline derivate drugs in market or clinical trials, classified them into five major categories with detailed targets according to their main mechanisms, discussed the relationship within the same mechanism, and generated a summative discussion with prospective expectations. For each mechanism, the introduction of the target was presented, with the typical examples of quinoline derivate drugs.

CONCLUSION

This review has highlighted the quinoline drugs or candidates, suited them into corresponding targets in their pathways, summarized and discussed. We hope that this review may help the researchers who are interested in discovering quinoline derivate anti-cancer agents obtain considerable understanding of this specific topic. Through the flourishing period and the vigorous strategies in clinical trials, quinoline drugs would be potential but facing new challenges in the future.