High-Dimensional Precision Medicine From Patient-Derived Xenografts

The complexity of human cancer often results in significant heterogeneity in response to treatment. Precision medicine offers the potential to improve patient outcomes by leveraging this heterogeneity. Individualized treatment rules (ITRs) formalize precision medicine as maps from the patient covariate space into the space of allowable treatments. The optimal ITR is that which maximizes the mean of a clinical outcome in a population of interest. Patient-derived xenograft (PDX) studies permit the evaluation of multiple treatments within a single tumor, and thus are ideally suited for estimating optimal ITRs. PDX data are characterized by correlated outcomes, a high-dimensional feature space, and a large number of treatments. Here we explore machine learning methods for estimating optimal ITRs from PDX data. We analyze data from a large PDX study to identify biomarkers that are informative for developing personalized treatment recommendations in multiple cancers. We estimate optimal ITRs using regression-based (Q-learning) and direct-search methods (outcome weighted learning). Finally, we implement a superlearner approach to combine multiple estimated ITRs and show that the resulting ITR performs better than any of the input ITRs, mitigating uncertainty regarding user choice. Our results indicate that PDX data are a valuable resource for developing individualized treatment strategies in oncology. Supplementary materials for this article are available online.

Estimating individualized treatment rules for ordinal treatments

Precision medicine is an emerging scientific topic for disease treatment and prevention that takes into account individual patient characteristics. It is an important direction for clinical research, and many statistical methods have been proposed recently. One of the primary goals of precision medicine is to obtain an optimal individual treatment rule (ITR), which can help make decisions on treatment selection according to each patient's specific characteristics. Recently, outcome weighted learning (OWL) has been proposed to estimate such an optimal ITR in a binary treatment setting by maximizing the expected clinical outcome. However, for ordinal treatment settings, such as individualized dose finding, it is unclear how to use OWL. In this article, we propose a new technique for estimating ITR with ordinal treatments. In particular, we propose a data duplication technique with a piecewise convex loss function. We establish Fisher consistency for the resulting estimated ITR under certain conditions, and obtain the convergence and risk bound properties. Simulated examples and an application to a dataset from a type 2 diabetes mellitus observational study demonstrate the highly competitive performance of the proposed method compared to existing alternatives.

Tree based weighted learning for estimating individualized treatment rules with censored data

Estimating individualized treatment rules is a central task for personalized medicine. [23] and [22] proposed outcome weighted learning to estimate individualized treatment rules directly through maximizing the expected outcome without modeling the response directly. In this paper, we extend the outcome weighted learning to right censored survival data without requiring either inverse probability of censoring weighting or semiparametric modeling of the censoring and failure times as done in [26]. To accomplish this, we take advantage of the tree based approach proposed in [28] to nonparametrically impute the survival time in two different ways. The first approach replaces the reward of each individual by the expected survival time, while in the second approach only the censored observations are imputed by their conditional expected failure times. We establish consistency and convergence rates for both estimators. In simulation studies, our estimators demonstrate improved performance compared to existing methods. We also illustrate the proposed method on a phase III clinical trial of non-small cell lung cancer.

Discussion of combining biomarkers to optimize patient treatment recommendations

Kang, Janes and Huang propose an interesting boosting method to combine biomarkers for treatment selection. The method requires modeling the treatment effects using markers. We discuss an alternative method, outcome weighted learning. This method sidesteps the need for modeling the outcomes, and thus can be more robust to model misspecification.