Background: There are a plethora of potential statistical designs which can be used to evaluate efficacy of a novel cancer treatment in the phase II clinical trial setting. Unfortunately, there is no consensus as to which design one should prefer, nor even which definition of efficacy should be used and the primary endpoint conclusion can vary depending on which design is chosen. It would be useful if an all-encompassing methodology was possible which could evaluate all the different designs simultaneously and allow investigators an understanding of the trial results under the varying scenarios. Methods: Finite Markov chain imbedding is a method which can be used in the setting of phase II oncology clinical trials but never previously evaluated in this scenario. Simple variations to the transition matrix or end-state probability definitions can be performed which allow for evaluation of multiple designs and endpoints for a single trial. A computer program is written in R which allows for computation of p-values and conditional power, two common statistical measures used for evaluation of trial results. A simulation study is performed on data arising from an actual phase II clinical trial performed recently in which the study conclusion regarding the efficacy of the potential treatment was debatable. Results: Finite Markov chain imbedding is shown to be useful for evaluating phase II oncology clinical trial results. The R code written for evaluating the simulation study is demonstrated to be fast and useful for investigating different trial designs. Further detail regarding the clinical trial results are presented, including the potential prolongation of stable disease of the treatment, which is a potentially useful marker of efficacy for this cytostatic agent. Conclusions: This novel methodology may prove to be an useful investigative technique for the evaluation of phase II oncology clinical trial data. Future studies which have disputable conclusions might become less controversial with the aid of finite Markov chain imbedding and the possible multiple evaluations which is now viable. Better understanding of activity for a given treatment might expedite the drug development process or help distinguish active from inactive treatments

Background: There are a plethora of potential statistical designs which can be used to evaluate efficacy of a novel cancer treatment in the phase II clinical trial setting. Unfortunately, there is no consensus as to which design one should prefer, nor even which definition of efficacy should be used and the primary endpoint conclusion can vary depending on which design is chosen. It would be useful if an all-encompassing methodology was possible which could evaluate all the different designs simultaneously and allow investigators an understanding of the trial results under the varying scenarios. Methods: Finite Markov chain imbedding is a method which can be used in the setting of phase II oncology clinical trials but never previously evaluated in this scenario. Simple variations to the transition matrix or end-state probability definitions can be performed which allow for evaluation of multiple designs and endpoints for a single trial. A computer program is written in R which allows for computation of p-values and conditional power, two common statistical measures used for evaluation of trial results. A simulation study is performed on data arising from an actual phase II clinical trial performed recently in which the study conclusion regarding the efficacy of the potential treatment was debatable. Results: Finite Markov chain imbedding is shown to be useful for evaluating phase II oncology clinical trial results. The R code written for evaluating the simulation study is demonstrated to be fast and useful for investigating different trial designs. Further detail regarding the clinical trial results are presented, including the potential prolongation of stable disease of the treatment, which is a potentially useful marker of efficacy for this cytostatic agent. Conclusions: This novel methodology may prove to be an useful investigative technique for the evaluation of phase II oncology clinical trial data. Future studies which have disputable conclusions might become less controversial with the aid of finite Markov chain imbedding and the possible multiple evaluations which is now viable. Better understanding of activity for a given treatment might expedite the drug development process or help distinguish active from inactive treatments

The Finkelstein and Schoenfeld (FS) test is a popular generalized pairwise comparison approach to analyze prioritized composite endpoints (e.g., components are assessed in order of clinical importance). Power and sample size estimation for the FS test, however, are generally done via simulation studies. This simulation approach can be extremely computationally burdensome, compounded by an increasing number of composite endpoints and with increasing sample size. We propose an analytic solution to calculate power and sample size for commonly encountered two-component hierarchical composite endpoints. The power formulas are derived assuming underlying distributions in each of the component outcomes on the population level, which provide a computationally efficient and practical alternative to the standard simulation approach. The proposed analytic approach is extended to derive conditional power formulas, which are used in combination with the promising zone methodology to perform sample size re-estimation in the setting of adaptive clinical trials. Prioritized composite endpoints with more than two components are also investigated. Extensive Monte Carlo simulation studies were conducted to demonstrate that the performance of the proposed analytic approach is consistent with that of the standard simulation approach. We also demonstrate through simulations that the proposed methodology possesses generally desirable objective properties including robustness to mis-specified underlying distributional assumptions. We illustrate our proposed methods through application of the proposed formulas by calculating power and sample size for the Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT) and the EMPULSE trial for empagliozin treatment of acute heart failure.

A common approach to adapt the design of a clinical trial based on interim results is sample size re-estimation (SSR). SSR allows an increase in the trial's sample size in order to maintain, at the desired nominal level, the desired power to reject the null hypothesis conditioned on the interim observed treatment effect and its variance (i.e., the conditional power). There are several established approaches to SSR for clinical studies with independent and identically distributed observations; however, no established methods have been developed for trials where there is more than one observation collected per subject where within-subject correlation exists. Without accurately accounting for the within-subject correlation in SSR, a sponsor may incorrectly estimate the trial's conditional power to obtain statistical significance at the final analysis and hence risk overestimating or underestimating the number of patients required to complete the trial as planned. In this dissertation, we propose an extension of Mehta and Pocock's promising zone approach to SSR that reconciles the within-subject correlation in the data for a variety of superiority clinical trials. We consider trials with continuous and binary primary endpoints, and further we explore cases where patients contribute both the same and varying numbers of observations to the analysis of the primary endpoint. Using a simulation study, we show that in each case, our proposed conditional power formula accurately calculates conditional power and our proposed SSR methodology preserves the nominal type I error rate under the null hypothesis and maintains adequate power under the alternative hypothesis. Additionally, we demonstrate the robustness of our methodology to the mis-specification of a variety of distributional assumptions regarding the underlying population from which the data arise. / 2024-06-21T00:00:00Z