Imagine if we were to count the number of possible reasons that investigators might have for monitoring a biomarker during a clinical trial, and multiply that number by the number of possible adaptive designs available for such investigation. We would naturally assume that whatever the number, it would be rather large. This poses an interesting question for a sponsor of an adaptive clinical trial. Are there any general principles for trial design that may be gleaned from these various possible scenarios?
Sep 4, 2014 1:10:00 PM
Sep 2, 2014 11:19:00 AM
As more clinical trials make use of adaptive designs, investors have come to realize that high quality trial designs can result in significant improvements to a trial’s financial risk profile. Regardless of a trial’s eventual success or failure, a well-constructed design provides a drug with the highest possible probability of success while mitigating financial risk.
Aug 28, 2014 8:00:00 AM
Aug 19, 2014 8:48:00 AM
Biostatisticians from Cytel will be delivering a course on adaptive designs at this year’s International Society for Clinical Biostatistics. The course will help attendees develop strategies for interim decision-making, by providing an overview of recent advances in statistical methodology and applying them to case studies in oncology and cardiology
Members of Cytel Consulting are not only expert biostatisticians. In addition, they have practical experience designing adaptive trials for some of the leading biopharmaceutical companies in the industry. They will draw on this experience to cover topics on:
Topics: Adaptive Clinical Trials
Aug 14, 2014 8:00:00 AM
Cytel statisticians are looking foward to attending the Conference of the International Society for Clinical Biostatistics, which will be held in Vienna during the week of August 24th. Members of Cytel will be contributing to four sessions at this conference, including an invited talk on innovation entitled 'Beyond Wild Horses: Developing Innovation at Cytel.' They will also be contributing to a session called Adaptive Designs II, in which they will discuss Backward Image Confidence Intervals, a solution to the problem of parameter estimation at the end of an adaptive trial.
Jul 29, 2014 6:30:00 AM
Adaptive designs are the unsurprising hot topic of this year’s Joint Statistical Meeting, which features over one hundred and thirty sessions on the subject. Statisticians at Cytel look forward to contributing to the dialogue with two papers on adaptive designs, and a workshop for using simulations to benefit from interim data (i.e. for prediction and trial forecasting.) In addition, Cytel Senior Director & Consultant Jim Bolognese has organized a session on making use of adaptive designs to optimize strategy for drug development programs.
In the Ernst & Young 2014 Biotechnology Industry Report, Cytel CTO Nitin Patel writes: "Historically, biotechnology companies haven't fully appreciated the link between trial design and the ability to secure external financing. Yet, adaptive trial designs - which often reduce the risk, time and cost associated with clinical development - can make the math more attractive for investors." [Beyond Borders, p. 20].
Jul 10, 2014 1:53:00 PM
Complexities with identifying suitable test populations in oncology studies contribute significantly to the 60% attrition rate in Phase III trials. Cyrus Mehta, (President of Cytel) has recently authored a paper on ‘Biomarker Driven Population Enrichment for Adaptive Oncology Trials,’ (forthcoming in Statistics in Medicine) which provides an innovative method for using two-stage adaptive designs for population enrichment.
Mehta, et al., are sensitive to the dilemma faced by Phase III trial designers choosing between open and restricted enrollment. Open enrollment allows for a large number of patients, and ensures that all patients who may benefit from a therapy have an opportunity to be involved. By contrast, limiting enrollment is a superior practice for revealing the efficacy of a trial for a targeted population. The proposed method allows for biomarker driven enrichment at interim analysis, meaning that only those subgroups that appear to benefit from therapy need to progress to the second stage of the trial.
Jul 8, 2014 6:00:00 AM
The above graphic is from Cyrus Mehta's slides on 'Adaptive Population Enrichment for Oncology Trials with Time to Event Endpoints.'
Recent advances in precision medicine have meant that therapeutic treatments can now target subsets of a population that are most likely to respond well to treatment. Identification of such subsets largely relies on the presence or absence of particular biomarkers. In order to determine whether or not such biomarkers have predictive diagnostic capabilities, the biomarkers must first be validated as reliable predictive indicators, and thereafter as responding efficaciously to treatment.
Jul 1, 2014 9:47:00 AM
A recent Cytel Seminar on Adaptive Statistical Designs featured a talk by Michael Elashoff (Patient Profiles) on Multivariate Approaches for Risk-Based Monitoring. Elashoff, a former statistical reviewer at the Food and Drug Administration, recommended combining cluster and rules based methods for statistical monitoring. Such adaptive monitoring approaches can substantially reduce the time and expense of data monitoring while ensuring consistently high data quality.
Jun 26, 2014 8:44:00 AM
The rise of biomarker based treatments in oncology has meant a reconceptualization of what constitutes a particular disease. According to the American Society for Clinical Oncology, “We can no longer think of cancer as one disease. Even something like lung cancer could be hundreds of different cancers, each defined by specific molecular characteristics requiring different treatment approaches.”  This means that many oncology trials are slowly moving from large-scale studies of generic populations, towards a system where targeted therapies are offered to smaller sets of patients who all possess certain genetic characteristics.
Nina Selaru of Pfizer Oncology, recently gave a talk at a Cytel Seminar in San Diego in which she described a trial for Xalkori, a therapy for non-small cell lung cancer (NSCLC). Pfizer conducted two Phase 3 trials for Xalkori, one for patients who possessed anaplastic lymphoma kinase (ALK-positive patients) and another for other ‘unselected’ patients. The ALK-positive patients were found to respond very well to treatment. Unfortunately, the ALK-positive patients also displayed certain characteristics not present in the other patients: they were younger, non-smokers who displayed signs of adenocarcinoma. There was concern that these characteristics were driving the efficacy of Xalkori.
Jun 5, 2014 9:37:00 AM
In the US, cancer is the most common cause of death after heart disease, accounting for nearly 1 of every 4 deaths . Tackling the immense burden of this disease, researchers are currently investigating an estimated 900 novel cancer agents in over 6,000 clinical trials . Unfortunately, the clinical success rate remains low, and failed trials amount to billions of dollars invested, while providing little direct benefit to patients. Such failures also discourage patients from participating in the testing of novel treatments: Currently, less than 2% of cancer patients enroll in clinical trials .
May 16, 2014 2:48:00 PM
Cytel Consulting's Zoran Antonijevic
The key focus of precision medicine is identification of patients who would most benefit from a treatment. Proper enrichment of patient population greatly improves the probability of regulatory approval as well as product differentiation through improved efficacy and safety. Greater product differentiation leads to greater market access, as reimbursement is now a key driver to commercial success.
May 13, 2014 8:31:00 AM
The VALOR trial recently applied a promising zone design to a Phase 3 evaluation of Vosaroxin, a candidate for the treatment of relapsed/refractory acute myeloid leukemia. CMO Dr. Adam Craig reports that there were intial anxieties about financing a trial that required 800 patients. However, a promising interim look raised investors' confidence in the treatment's success, leading to a high-powered trial of 712 patients.
To view a YouTube video of Dr. Adam Craig talking about the Phase 3 VALOR trial, click below.
May 5, 2014 10:21:00 PM
A new JAMA study on discontinued randomized trials in Switzerland, Germany and Canada, reports that poor recruitment accounts for 101 out of 253 trials that were eventually discontinued (or about 10% of the 1017 trials which participated in the study). When restricted to industry-sponsored trials with non-healthy volunteers, poor recruitment accounted for the discontinuation of 40 trials out of 119 that were discontinued. Across the board, poor recruitment was the foremost cause of trial discontinuity.