Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Feb 15;17(4):640-6.
doi: 10.1158/1078-0432.CCR-10-1262. Epub 2010 Dec 6.

Seamless phase I-II trial design for assessing toxicity and efficacy for targeted agents

Affiliations

Seamless phase I-II trial design for assessing toxicity and efficacy for targeted agents

Antje Hoering et al. Clin Cancer Res. .

Abstract

Purpose: The premise for phase I trials for cytostatic agents is different from that of cytotoxic agents. For cytostatic agents, toxicity and efficacy do not necessarily increase monotonically with increasing dose levels, but likely plateau after they reach maximal toxicity or efficacy. Here, we propose a phase I-II trial design to assess both toxicity and efficacy to find the best dose as well as a good dose.

Experimental design: We propose a 2-step dose-finding trial for assessing both toxicity and efficacy for a targeted agent. The 1st step uses a traditional phase I trial design. This step only assesses toxicity and finds the maximal tolerated dose (MTD). For the 2nd step, we propose a modified phase II selection design for 2 or 3 dose levels at and below the MTD to determine efficacy and evaluate each dose level by both efficacy and toxicity.

Results and conclusion: Simulation studies are done on several combinations of toxicity and efficacy scenarios to assess the operating statistics of our proposed trial design. We then compare our results with a traditional phase I trial followed by a single-arm phase II trial using the same total sample size. The proposed design does better in most cases than a traditional design using the same overall sample size. This design allows assessing a few dose levels more closely for both efficacy and toxicity and provides greater certainty of having correctly determined the best dose level before launching into a large efficacy trial.

PubMed Disclaimer

Conflict of interest statement

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Figures

Figure 1
Figure 1
Possible response scenarios as a function of dose level. The marginal probabilities as a function of dose level are plotted.
Figure 2
Figure 2
Possible toxicity scenarios as a function of dose level. The marginal probabilities as a function of dose level are plotted.
Figure 3
Figure 3
Possible ways to select a good dose or the best dose level using our proposed design for response scenarios R1 and R2. Good dose levels as defined by toxicity and efficacy are in red. The best dose levels are circled in blue.

References

    1. Storer BE. Choosing a phase I design. In: Crowley J, Power Ankerst D, editors. Handbook of statistics in clinical oncology. 2. Boca Raton (FL): CRC Press; 2006. pp. 59–75.
    1. Thall PF, Cook JD. Dose-finding based on efficacy-toxicity trade offs. Biometrics. 2004;60:684–93. - PubMed
    1. Zhang W, Sargent DJ, Mandrekar S. An adaptive dose-finding design incorporating both toxicity and efficacy. Stat Med. 2006;25:2365–83. - PubMed
    1. Hunsberger S, Rubinstein LV, Dancey J, Korn EL, et al. Dose escalation trial designs based on a molecularly targeted endpoint. Stat Med. 2005;24:2171–81. - PubMed
    1. Jain RK, Lee JJ, Hong D, Markman M, Gong J, Naing A, et al. Phase I oncology studies: evidence that in the era of targeted therapies patients on lower doses do not fare worse. Clin Cancer Res. 2010;16:1289–97. - PMC - PubMed

Publication types

Substances