针对性剂持续重新评估方法:用于分子向疗法的第一阶段试验的新贝叶斯式丰富设计
Clement Ma1,2, David S Shulman1,2, Hasan Al-Sayegh1
1Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA.
JCO precision oncology
|December 23, 2024
概括
新型的TARGET-CRM设计改善了早期阶段试验中罕见基因组改变的癌症患者的入学情况. 与传统设计相比,这种自适应方法优化了剂量发现,同时保持了试验的安全性和准确性.
科学领域:
- 在瘤学瘤学.
- 临床试验设计 临床试验设计
- 基因组学就是基因组学.
背景情况:
- 针对性治疗对复发性/耐药性癌症具有前景,患者的反应通常与特定的基因组变化有关.
- 优化临床试验设计以招募患有这些特定变化的患者对于治疗开发至关重要.
- 目前的试验设计往往无法为那些最有可能从向药物中受益的患者提供丰富的信息.
研究的目的:
- 开发和评估适应性定向药物持续重新评估方法 (TARGET-CRM) 以优化早期瘤学试验中的剂量发现.
- 加强在I期试验中注册具有特定基因组改变的患者.
- 将TARGET-CRM的性能与标准CRM和3+3设计进行比较.
主要方法:
- 根据瘤类型和罕见基因组变异的存在,患者被分为分层.
- 根据TARGET-CRM的设计,罕见基因组变异的患者可以在较低的剂量水平上注册.
- 使用模拟来比较不同试验设计中的B队列患者的准确性,安全性 (DLT率) 和入学比例.
主要成果:
- 与CRM (~85%) 和3+3 (~79%) 相比,TARGET-CRM实现了较高的罕见基因组变异患者 (90%-100%) 的注册率.
- 剂量限制性毒性 (DLT) 率和确定最大耐受剂量 (MTD) 的准确性在TARGET-CRM和CRM之间是可比的.
- 这些发现在各种试验样本大小和患者群体组成中保持一致.
结论:
- 贝叶斯适应性TARGET-CRM设计有效地最大限度地增加了可能响应向药物的患者在I期剂量检测试验中的注册人数.
- 与传统的CRM和3+3设计相比,TARGET-CRM表现出类似或更高的准确性和安全性.
- 这种适应性设计对于涉及瘤学向治疗的试验来说是一个重大进步.
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