Improving Maximum Tolerated Dose Selection in Model-Assisted Designs for Phase I Trials Through Bayesian...

Model-assisted designs have garnered significant attention in recent years due to their high accuracy in identifying the maximum tolerated dose (MTD) and their operational simplicity. To identify the MTD, they employ estimated dose limiting toxicity (DLT) probabilities via isotonic regression with pool-adjacent violators algorithm (PAVA) after trials have been completed. PAVA adjusts independently estimated DLT probabilities with the Bayesian binomial model at each dose level using posterior variances ensure the monotonicity that toxicity increases with dose. However, in small sample settings such as Phase I oncology trials, this approach can lead to unstable DLT probability estimates and reduce MTD selection accuracy. To address this problem, we propose a novel MTD identification strategy in model-assisted designs that leverages a Bayesian dose-response model. Employing the dose-response model allows for stable estimation of the DLT probabilities under the monotonicity by borrowing information across dose levels, leading to an improvement in MTD identification accuracy. We discuss the specification of prior distributions that can incorporate information from similar trials or the absence of such information. We examine dose-response models employing logit, log-log, and complementary log-log link functions to assess the impact of link function differences on the accuracy of MTD selection. Through extensive simulations, we demonstrate that the proposed approach improves MTD selection accuracy by more than 10% in some scenarios and by approximately 6% on average compared to conventional approach. These findings indicate that the proposed approach can contribute to further enhancing the efficiency of Phase I oncology trials.