Envelope Simulation: A New Adaptive Method for Dose Optimization/* Layout-provided Styles */div.standard { margin-bottom: 2ex;}

Abstract

We present a flexible and general adaptive experimental design for dose finding clinical trials. This method can be applied in sterotypical settings such as determining a maximum tolerated dose, when the dose response relationship is complex, or when the response is an arbitrary quantitative measure. Our design generalizes dose finding methods such as the continual reassessment method (CRM), modified CRM, and estimation with overdose control (EWOC). Similar to those, our design requires a working mathematical model, which assures efficiency, low bias, and a higher fraction of dose selected near the optimum compared to purely operational designs. Unlike typical model based designs that always employ the same model, our method allows individual dose response models tailored to the circumstance. Simulations are also integral to our design allowing it to account for both known and unknown effects of dose on outcome. This method is applicable to general dose finding problems such as those encountered with modern targeted anti-cancer agents, immunotherapies, and titrations against biomarker outcome measures. The method can also support improvements in the design of the experiment being conducted by providing a platform for concurrent simulations to assess the influence of projected design points. Although we present the design in the context of clinical trials, it is equally applicable to experiments with non-human subjects.