Problem
Research questions and friction points this paper is trying to address.
dose-optimization
monotherapy
combination therapy
oncology
A seamless dose-optimization design for monotherapy and combination therapy
🤖 AI Summary
本文提出一种无缝剂量优化设计，通过适应性子试验和患者回填方法，解决单药和联合疗法的剂量优化问题，平衡疗效与耐受性。
📝 Abstract
The emergence of molecular-targeted agents and immune-oncology therapies has fundamentally transformed oncology drug development, necessitating evolution beyond traditional dose-finding approaches designed for cytotoxic agents. While conventional agents exhibit predictable monotonic dose-response relationships, novel anticancer agents often demonstrate plateau-effect patterns where higher doses may compromise therapeutic benefit, requiring identification of optimal biological doses that balance efficacy and tolerability. The FDA's Project Optimus initiative emphasizes comprehensive dose optimization through parallel randomized cohorts and patient backfilling to better understand pharmacological profiles across multiple dose levels. Contemporary drug development increasingly prioritizes combination therapy alongside monotherapy evaluation, yet existing designs typically assume equivalent roles for both agents, diverging from clinical practice where novel agents combine with established treatments having limited dose options. This paper proposes a seamless dose-optimization design that adaptively evaluates both monotherapy and combination therapy based on efficacy and toxicity outcomes through adaptive subtrials with patient backfilling capabilities. The model-assisted framework employs predetermined Bayesian optimal boundaries, eliminating real-time model fitting while accommodating evaluation of both monotherapy and combination therapy and enabling sequential enrollment with strategic backfilling. Simulation studies demonstrate robust performance across diverse dose-response patterns relevant to contemporary oncology. The design addresses critical gaps between methodological assumptions and clinical reality, offering a practical approach that integrates monotherapy and combination therapy evaluation with efficacy-toxicity-based backfilling.
Innovation
Methods, ideas, or system contributions that make the work stand out.
seamless dose-optimization
adaptive subtrials
patient backfilling
Bayesian optimal boundaries
combination therapy
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