1
|
Zhao Y, Yuan Y, Korn EL, Freidlin B. Backfilling Patients in Phase I Dose-Escalation Trials Using Bayesian Optimal Interval Design (BOIN). Clin Cancer Res 2024; 30:673-679. [PMID: 38048044 DOI: 10.1158/1078-0432.ccr-23-2585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
In recent years, there has been increased interest in incorporation of backfilling into dose-escalation clinical trials, which involves concurrently assigning patients to doses that have been previously cleared for safety by the dose-escalation design. Backfilling generates additional information on safety, tolerability, and preliminary activity on a range of doses below the maximum tolerated dose (MTD), which is relevant for selection of the recommended phase II dose and dose optimization. However, in practice, backfilling may not be rigorously defined in trial protocols and implemented consistently. Furthermore, backfilling designs require careful planning to minimize the probability of treating additional patients with potentially inactive agents (and/or subtherapeutic doses). In this paper, we propose a simple and principled approach to incorporate backfilling into the Bayesian optimal interval design (BOIN). The design integrates data from the dose-escalation and backfilling components of the design and ensures that the additional patients are treated at doses where some activity has been seen. Simulation studies demonstrated that the proposed backfilling BOIN design (BF-BOIN) generates additional data for future dose optimization, maintains the accuracy of the MTD identification, and improves patient safety without prolonging the trial duration.
Collapse
Affiliation(s)
- Yixuan Zhao
- Department of Biostatistics, University of Texas Health Science Center, Houston, Texas
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Texas
| | - Edward L Korn
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Boris Freidlin
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| |
Collapse
|
2
|
Lee SM, Wages NA, Goodman KA, Lockhart AC. Reply to M. Ratain. JCO Precis Oncol 2021; 5:937-938. [DOI: 10.1200/po.21.00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shing M. Lee
- Shing M. Lee, PhD, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; Nolan A. Wages, PhD, Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA; Karyn A. Goodman, MD, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; and A. Craig Lockhart, MD, MHS, Division of Medical Oncology, University of Miami, Sylvester Comprehensive Cancer
| | - Nolan A. Wages
- Shing M. Lee, PhD, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; Nolan A. Wages, PhD, Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA; Karyn A. Goodman, MD, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; and A. Craig Lockhart, MD, MHS, Division of Medical Oncology, University of Miami, Sylvester Comprehensive Cancer
| | - Karyn A. Goodman
- Shing M. Lee, PhD, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; Nolan A. Wages, PhD, Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA; Karyn A. Goodman, MD, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; and A. Craig Lockhart, MD, MHS, Division of Medical Oncology, University of Miami, Sylvester Comprehensive Cancer
| | - A. Craig Lockhart
- Shing M. Lee, PhD, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; Nolan A. Wages, PhD, Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA; Karyn A. Goodman, MD, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; and A. Craig Lockhart, MD, MHS, Division of Medical Oncology, University of Miami, Sylvester Comprehensive Cancer
| |
Collapse
|