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A review of phase 2–3 clinical trial designs

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Abstract

This article reviews phase 2–3 clinical trial designs, including their genesis and the potential role of such designs in treatment evaluation. The paper begins with a discussion of the many scientific flaws in the conventional phase 2 → phase 3 treatment evaluation process that motivate phase 2–3 designs. This is followed by descriptions of some particular phase 2–3 designs that have been proposed, including two-stage designs to evaluate one experimental treatment, a design that accommodates both frontline and salvage therapy in oncology, two-stage select-and-test designs that evaluate several experimental treatments, dose-ranging designs, and a seamless phase 2–3 design based on both early response-toxicity outcomes and later event times. A general conclusion is that, in many circumstances, a properly designed phase 2–3 trial utilizes resources much more efficiently and provides much more reliable inferences than conventional methods.

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References

  • Bechhofer RE, Santner TJ and Goldsman DM (1995). Design and analysis of experiments for statistical selection, screening and multiple comparisons. John Wiley and Sons, New York, NY

    Google Scholar 

  • Berry DA, Mueller P, Grieve AP, Smith M, Parke T, Blazek R, Mitchard N, Krams M (2001) Adaptive Bayesian designs for dose-ranging drug trials. In: Gatsonis C, Kass RE, Carlin B, Carriquiry A, Gelman A, Verdinelli I, West M (eds) Case studies in Bayesian statistics, V 99–181. New York, NY, Springer-Verlag

  • Braun TM, Thall PF, Nguyen H, de Lima M (2007) Simultaneously optimizing dose and schedule of a new cytotoxic agent. Clin Trials, (in press)

  • Bryant J and Day R (1995). Incorporating toxicity considerations into the design of two-stage phase II clinical trials. Biometrics 51: 1372–1383

    Article  MATH  MathSciNet  Google Scholar 

  • Chang MN, Therneau TM, Wieand HS and Cha SS (1987). Designs for group sequential phase II clinical trials. Biometrics 43: 865–874

    Article  MATH  Google Scholar 

  • Ellenberg SS and Eisenberger MA (1985). An efficient design for phase III studies of combination chemotherapies. (with discussion). Cancer Treat Rep 69: 1147–1154

    Google Scholar 

  • Estey EH and Thall PF (2003). New designs for phase 2 clinical trials. Blood 102: 442–448

    Article  Google Scholar 

  • Fleming TR (1982). One sample multiple testing procedure for phase II clinical trials. Biometrics 38: 143–151

    Article  MATH  Google Scholar 

  • Gehan EA (1961). The determination of the number of patients required in a follow-up trial of a new chemotherapeutic agent. J Chronic Diseases 13: 346–353

    Article  Google Scholar 

  • Inoue LYT, Thall PF and Berry DA (2002). Seamlessly expanding a randomized phase II trial to phase III. Biometrics 58: 823–831

    Article  MathSciNet  Google Scholar 

  • Jennison C and Turnbull BW (2000). Group sequential methods with applications to clinical trials. Chapman and Hall, New York, NY

    MATH  Google Scholar 

  • Lavori PW and Dawson R (2004). Dynamic treatment regimes: practical design considerations. Clin Trials 1: 9–20

    Article  Google Scholar 

  • Liu Q and Pledger GW (2005). Phase 2 and 3 combination designs to accelerate drug development. J Am Stat Assoc 100: 493–502

    Article  MATH  MathSciNet  Google Scholar 

  • Murphy SA (2003). Optimal dynamic treatment regimes (with discussion). J Roy Stat Soc Ser B 65: 331–366

    Article  MATH  MathSciNet  Google Scholar 

  • Murphy SA (2005). An experimental design for the development of adaptive treatment strategies. Stat Med 24: 1455–1481

    Article  MathSciNet  Google Scholar 

  • Rubinstein LV, Korn EL, Freidlin B, Hunsberger S, Ivy P and Smith M (2005). Design issues of randomized phase II trials and a proposal for phase II screening trials. J Clin Oncol 23: 7199–7206

    Article  Google Scholar 

  • Schaid DJ, Ingle JN, Wieand S and Ahmann DL (1988). A design for phase II testing of anticancer agents within a phase III clinical trial. Controlled Clin Trials 9: 107–118

    Article  Google Scholar 

  • Schaid DJ, Wieand HS and Therneau TM (1990). Optimal two-stage screening designs for survival comparisons. Biometrika 77: 507–513

    Article  MathSciNet  Google Scholar 

  • Simon R (1989). Optimal two-stage designs for phase II clinical trials. Controlled Clin Trials 10: 1–10

    Article  Google Scholar 

  • Simon R, Wittes RE and Ellenberg SS (1985). Randomized phase II clinical trials. Cancer Treat Rep 69: 1375–1381

    Google Scholar 

  • Simon R, Thall PF, Ellenberg SS (1994) New designs for the selection of treatments to be tested in randomized clinical trials. Stat Med 13:417–429, (discussion pp 447–451)

    Google Scholar 

  • Spiegelhalter DJ, Abrams KR and Myles JP (2004). Bayesian approaches to clinical trials and health-care evaluation. John Wiley and Sons, New York, NY

    Google Scholar 

  • Thall PF and Cook JD (2004). Dose-finding based on efficacy-toxicity trade-offs. Biometrics 60: 684–693

    Article  MATH  MathSciNet  Google Scholar 

  • Thall PF and Simon R (1990). Incorporating historical control data in planning phase II clinical trials. Stat Med 9: 215–228

    Article  Google Scholar 

  • Thall PF and Simon R (1994). Practical Bayesian guidelines for phase IIB clinical trials. Biometrics 50: 337–349

    Article  MATH  MathSciNet  Google Scholar 

  • Thall PF, Simon R, Ellenberg SS and Shrager R (1988a). Optimal two-stage designs for clinical trials with binary response. Stat Med 71: 571–579

    Article  Google Scholar 

  • Thall PF, Simon R and Ellenberg SS (1988b). Two-stage selection and testing designs for comparative clinical trials. Biometrika 75: 303–310

    Article  MATH  Google Scholar 

  • Thall PF, Simon R and Ellenberg SS (1989). A two-stage design for choosing among several experimental treatments and a control in clinical trials. Biometrics 45: 537–547

    Article  MATH  MathSciNet  Google Scholar 

  • Thall PF, Simon R and Estey EH (1995). Bayesian sequential monitoring designs for single-arm clinical trials with multiple outcomes. Stat Med 14: 357–379

    Article  Google Scholar 

  • Thall PF, Millikan R and Sung H-G (2000). Evaluating multiple treatment courses in clinical trials. Stat Med 19: 1011–1028

    Article  Google Scholar 

  • Thall PF, Sung H-G and Estey EH (2002). Selecting therapeutic strategies based on efficacy and death in multi-course clinical trials. J Am Stat Assoc 97: 29–39

    Article  MATH  MathSciNet  Google Scholar 

  • Thall PF, Wooten LH, Logothetis CJ, Millikan R, Tannir NM Bayesian and frequentist two-stage treatment strategies based on sequential failure times subject to interval censoring. Stat Med. (in press)

  • Therneau TM, Wieand HS and Chang M (1990). Optimal designs for a grouped sequential binomial test. Biometrics 46: 771–781

    Article  MATH  MathSciNet  Google Scholar 

  • Torri V, Simon R, Russek-Cohen E, Midthune D and Friedman M (1992). Statistical model to determine the relationship of response and survival in patients with advanced ovarian cancer treated with chemotherapy. J Nat Cancer Institute 84(6): 407–413

    Article  Google Scholar 

  • Whitehead J (1986). Sample sizes for phase II and phase III clinical trials: an integrated approach. Stat Med 5: 459–464

    Article  Google Scholar 

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Correspondence to Peter F. Thall.

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Thall, P.F. A review of phase 2–3 clinical trial designs. Lifetime Data Anal 14, 37–53 (2008). https://doi.org/10.1007/s10985-007-9049-x

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  • DOI: https://doi.org/10.1007/s10985-007-9049-x

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