New Statistical Designs for Clinical Trials of Immunomodulating Agents

2020 ◽  
pp. 539-550
Author(s):  
Richard Simon
2000 ◽  
Vol 8 (3) ◽  
pp. 183-193 ◽  
Author(s):  
Robert Oehmke ◽  
Janis Hardwick ◽  
Quentin F. Stout

We present a scalable, high-performance solution to multidimensional recurrences that arise in adaptive statistical designs. Adaptive designs are an important class of learning algorithms for a stochastic environment, and we focus on the problem of optimally assigning patients to treatments in clinical trials. While adaptive designs have significant ethical and cost advantages, they are rarely utilized because of the complexity of optimizing and analyzing them. Computational challenges include massive memory requirements, few calculations per memory access, and multiply-nested loops with dynamic indices. We analyze the effects of various parallelization options, and while standard approaches do not work well, with effort an efficient, highly scalable program can be developed. This allows us to solve problems thousands of times more complex than those solved previously, which helps make adaptive designs practical. Further, our work applies to many other problems involving neighbor recurrences, such as generalized string matching.


2007 ◽  
Vol 25 (31) ◽  
pp. 4982-4986 ◽  
Author(s):  
André Rogatko ◽  
David Schoeneck ◽  
William Jonas ◽  
Mourad Tighiouart ◽  
Fadlo R. Khuri ◽  
...  

Purpose Phase I clinical trials of new anticancer therapies determine suitable doses for further testing. Optimization of their design is vital in that they enroll cancer patients whose well-being is distinctly at risk. This study examines the effectiveness of knowledge transfer about more effective statistical designs to clinical practice. Methods We examined abstract records of cancer phase I trials from the Science Citation Index database between 1991 and 2006 and classified them into clinical (dose-finding trials) and statistical trials (methodologic studies of dose-escalation designs). We then mapped these two sets by tracking which trials adopted new statistical designs. Results One thousand two hundred thirty-five clinical and 90 statistical studies were identified. Only 1.6% of the phase I cancer trials (20 of 1,235 trials) followed a design proposed in one of the statistical studies. These 20 clinical studies showed extensive lags between publication of the statistical paper and its translation into a clinical paper. These 20 clinical trials followed Bayesian adaptive designs. The remainder used variations of the standard up-and-down method. Conclusion A consequence of using less effective designs is that more patients are treated with doses outside the therapeutic window. Simulation studies have shown that up-and-down designs treated only 35% of patients at optimal dose levels versus 55% for Bayesian adaptive designs. This implies needless loss of treatment efficacy and, possibly, lives. We suggest that regulatory agencies (eg, US Food and Drug Administration) should proactively encourage the adoption of statistical designs that would allow more patients to be treated at near-optimal doses while controlling for excessive toxicity.


Author(s):  
D. C. Swartzendruber ◽  
Norma L. Idoyaga-Vargas

The radionuclide gallium-67 (67Ga) localizes preferentially but not specifically in many human and experimental soft-tissue tumors. Because of this localization, 67Ga is used in clinical trials to detect humar. cancers by external scintiscanning methods. However, the fact that 67Ga does not localize specifically in tumors requires for its eventual clinical usefulness a fuller understanding of the mechanisms that control its deposition in both malignant and normal cells. We have previously reported that 67Ga localizes in lysosomal-like bodies, notably, although not exclusively, in macrophages of the spocytaneous AKR thymoma. Further studies on the uptake of 67Ga by macrophages are needed to determine whether there are factors related to malignancy that might alter the localization of 67Ga in these cells and thus provide clues to discovering the mechanism of 67Ga localization in tumor tissue.


2001 ◽  
Vol 120 (5) ◽  
pp. A284-A284
Author(s):  
B NAULT ◽  
S SUE ◽  
J HEGGLAND ◽  
S GOHARI ◽  
G LIGOZIO ◽  
...  

2001 ◽  
Vol 120 (5) ◽  
pp. A410-A410
Author(s):  
T KOVASC ◽  
R ALTMAN ◽  
R JUTABHA ◽  
G OHNING

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