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引用次数: 0
摘要
后期临床试验主要是为了确定一种新疗法在目标人群中的疗效。临床试验中人群异质性的一个必然结果是,一种治疗方法可能对一个或多个亚组有效,而不是对整个相关人群有效。例如,帕尼单抗在转移性结直肠癌患者中的 III 期临床试验未能证明其在总体人群中的疗效,但发现与肿瘤 KRAS 状态相关的一个亚组很有希望(Peeters 等(Am.J. Clin.Oncol.28 (2010) 4706-4713)).当我们通过基于大量生物标记物的数据分区来寻找此类亚组时,我们需要防止因多重检验而导致的I型错误率升高。常用的多重性调整往往会失去检测亚组治疗效应的能力。我们开发了一种有效的综合测试来检测是否存在至少一种亚组治疗效应,允许考虑大量可能的亚组和可能的删减结果。将该检验方法应用于帕尼单抗试验数据,可确认存在显著的亚组治疗效应。实证研究还表明,建议的检验适用于各种结果变量,并能保持强大的统计能力。
AN OMNIBUS TEST FOR DETECTION OF SUBGROUP TREATMENT EFFECTS VIA DATA PARTITIONING.
Late-stage clinical trials have been conducted primarily to establish the efficacy of a new treatment in an intended population. A corollary of population heterogeneity in clinical trials is that a treatment might be effective for one or more subgroups, rather than for the whole population of interest. As an example, the phase III clinical trial of panitumumab in metastatic colorectal cancer patients failed to demonstrate its efficacy in the overall population, but a subgroup associated with tumor KRAS status was found to be promising (Peeters et al. (Am. J. Clin. Oncol. 28 (2010) 4706-4713)). As we search for such subgroups via data partitioning based on a large number of biomarkers, we need to guard against inflated type I error rates due to multiple testing. Commonly-used multiplicity adjustments tend to lose power for the detection of subgroup treatment effects. We develop an effective omnibus test to detect the existence of, at least, one subgroup treatment effect, allowing a large number of possible subgroups to be considered and possibly censored outcomes. Applied to the panitumumab trial data, the proposed test would confirm a significant subgroup treatment effect. Empirical studies also show that the proposed test is applicable to a variety of outcome variables and maintains robust statistical power.
期刊介绍:
Statistical research spans an enormous range from direct subject-matter collaborations to pure mathematical theory. The Annals of Applied Statistics, the newest journal from the IMS, is aimed at papers in the applied half of this range. Published quarterly in both print and electronic form, our goal is to provide a timely and unified forum for all areas of applied statistics.