早期阶段试验的疗效和安全效应估计在第三阶段试验中进行测试时会回归
Angela Nelson1, Hannah Moyer1, Karine Vigneault1
1Department of Equity, Ethics and Policy, McGill University, Montreal, Quebec, Canada.
Journal of clinical epidemiology
|January 21, 2026
概括
对于固体瘤的早期药物试验往往高估了疗效. 第三阶段试验显示回归到平均值,这意味着结果往往不如最初的Ib/II阶段发现.
科学领域:
- 在瘤学瘤学.
- 临床试验 临床试验
- 生物统计学 生物统计学
背景情况:
- 在药物开发和患者护理方面的决策经常依赖于Ib/II期试验数据.
- 早期试验结果可能会因为回归到平均值和偏差而高估治疗疗效.
研究的目的:
- 评估实体瘤治疗的Ib/II期 (P1b/2) 和III期 (P3) 试验中的疗效和安全性估计之间的一致性.
- 确定P3效应大小是否在P1b/2结果的置信区间内,并分析影响回归的因素.
主要方法:
- 确定了P3固体瘤试验 (2014-2020年),并将其与相同药物指示的相应P1b/2试验相匹配.
- 评估了客观反应率 (ORR),平均整体存活率 (mOS) 和严重不良事件 (SAE) 的相关性.
- 检查了与试验设计特征相关的回归效应,包括偏差风险 (RoB).
主要成果:
- 在ORR (β=0.78),mOS (β=0.67) 和SAE率 (β=0.54) 的P1b/2和P3试验之间发现了显著的正相关性.
- 与高RoB相比,在低RoB的P3试验中,回归更为明显.
- 比P1b/2估计值低的P3估计值更有可能低于P1b/2估计值 (ORR:21%对10%,mOS:25%对6%,SAE:22%对4%).
结论:
- 早期阶段 (P1b/2) 实体瘤药物试验的有效性和毒性估计经常在后期阶段 (P3) 研究中表现出回归.
- 观察到的变异性强调了在使用早期试验数据进行临床决策时需要谨慎.
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