A Bayesian Precision Response-adaptive Phase II Clinical Trial Design for Radiotherapies with Competing Risk Survival Outcomes

TL;DR

This paper introduces a Bayesian adaptive trial design for radiotherapy that accounts for competing risks and patient heterogeneity, enabling personalized dose evaluation and improved treatment efficacy.

Contribution

It develops a novel Bayesian precision phase II trial methodology incorporating competing risks and subgroup-specific effects for radiotherapy.

Findings

The proposed design outperforms traditional methods in simulations.

Personalized dosing improves patient outcomes.

Adaptive randomization favors more effective doses.

Abstract

Many phase II clinical trials have used survival outcomes as the primary endpoints in recent decades. Suppose the radiotherapy is evaluated in a phase II trial using survival outcomes. In that case, the competing risk issue often arises because the time to disease progression can be censored by the time to normal tissue complications, and vice versa. Besides, much literature has examined that patients receiving the same radiotherapy dose may yield distinct responses due to their heterogeneous radiation susceptibility statuses. Therefore, the "one-dose-fit-all" strategy often fails, and it is more relevant to evaluate the subgroup-specific treatment effect with the subgroup defined by the radiation susceptibility status. In this paper, we propose a Bayesian precision phase II trial design evaluating the subgroup-specific treatment effects of radiotherapy. We use the cause-specific hazard approach to model the competing risk survival outcomes. We propose restricting the candidate radiation doses based on each patient's radiation susceptibility status. Only the clinically feasible personalized dose will be considered, which enhances the benefit for the patients in the trial. In addition, we propose a stratified Bayesian adaptive randomization scheme such that more patients will be randomized to the dose reporting more favorable survival outcomes. Numerical studies have shown that the proposed design performed well and outperformed the conventional design ignoring the competing risk issue.