论文标题
通过纳入匹配的对照患者来增强单臂II期试验
Enhancing single-arm phase II trials by inclusion of matched control patients
论文作者
论文摘要
当新型治疗成功通过了第一阶段时,可以使用不同的选择,以设计随后的II期试验。一种方法是一项单臂试验,将干预组的响应率与固定比例进行比较。另一种选择是进行随机II期试验,将新处理与安慰剂或当前标准进行比较。当研究的患者人群对预后因素非常异质时,两种方法都会出现一个重大问题。对于存在大量历史控制数据集的情况,我们提出了一种通过包括匹配的对照患者来增强经典单臂试验设计的方法。观察到的研究人群的结果可以根据匹配的对照组进行调整,并具有可比的已知混杂因子分布。我们提出了一种自适应的两阶段设计,可以选择早期停止,以徒劳和重新计算样本量,匹配率的数量,匹配伙伴的数量以及观察到的治疗效果。根据I型错误率,功率和预期样本量的拟议设计的性能通过基于假设的II期试验研究研究,该试验研究了针对急性髓样白血病患者的新疗法。
When a novel treatment has successfully passed phase I, different options to design subsequent phase II trials are available. One approach is a single-arm trial, comparing the response rate in the intervention group against a fixed proportion. Another alternative is to conduct a randomized phase II trial, comparing the new treatment with placebo or the current standard. A significant problem arises in both approaches when the investigated patient population is very heterogeneous regarding prognostic factors. For the situation that a substantial dataset of historical controls exists, we propose an approach to enhance the classic single-arm trial design by including matched control patients. The outcome of the observed study population can be adjusted based on the matched controls with a comparable distribution of known confounders. We propose an adaptive two-stage design with the options of early stopping for futility and recalculation of the sample size taking the matching rate, number of matching partners, and observed treatment effect into account. The performance of the proposed design in terms of type I error rate, power, and expected sample size is investigated via simulation studies based on a hypothetical phase II trial investigating a novel therapy for patients with acute myeloid leukemia.