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. 2024 Dec;20(12):1555-1558.
doi: 10.1200/OP.24.00217. Epub 2024 Jul 10.

Two-to-One Randomization: Rarely Advisable

Boris Freidlin  1 , Edward L Korn  1
Affiliations

Two-to-One Randomization: Rarely Advisable

Boris Freidlin et al. JCO Oncol Pract. 2024 Dec.

Abstract

In a randomized clinical trial, instead of allocating patients equally between the treatment arms, some trials in oncology assign a higher proportion of patients to receive the experimental treatment arm (eg, a two-to-one randomization). In this commentary, we first briefly review the common reasons given for the use of a two-to-one randomization and provide some examples of trials using these designs. We then explain why the risk-benefit ratio of this approach may not be favorable as is commonly assumed.

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