■传统上,在剂量发现临床试验中,治疗毒性和耐受性由临床医生评估。研究表明,临床医生报告的评分者间可靠性可能不足,与患者报告的结果相关性较差,并在捕获真正的毒性负担下。引入患者报告的结果(PRO),患者可以评估自己的症状不良事件或生活质量,有可能补充目前的做法,以帮助剂量优化。没有国际建议为将PRO纳入剂量发现试验设计和分析提供指导。我们的评论旨在识别和描述当前的统计方法和数据可视化技术,用于分析和可视化已发表的早期剂量发现肿瘤学试验(DFOTs)中的PRO数据。
■2016年6月至2022年12月发布的DFOTs,其中介绍了PRO分析方法,被纳入本方法学综述。我们在PubMed中提取了35篇符合条件的论文。提取的研究特征包括:PRO目标,PRO措施,统计分析和可视化技术,以及PRO是否参与中期和最终剂量选择决定。
■大多数论文(30,85.7%)没有明确的PRO目标。20篇(57.1%)论文使用推理统计技术来分析PRO,包括生存分析和混合效应模型。一项试验使用PRO对临床医生评估的剂量限制性毒性(DLT)进行分类。三项(8.6%)试验使用PRO来确认推荐剂量的耐受性。25份试验报告在其出版物中的图形或表格中直观地呈现PRO数据,其中12篇论文纵向呈现PRO评分。
■这篇评论强调了DFOT中PRO分析的统计方法和报告通常描述得很差,并且不一致。许多试验的PRO目标没有明确描述,这使得评估所使用的统计技术的适当性具有挑战性。根据不为PRO供电的DFOT得出结论可能会产生误导。由于没有早期DFOT中PROs分析方法的指导和标准化,比较不同试验的研究结果具有挑战性.因此,迫切需要建立国际指南,以增强剂量发现环境中PRO分析的统计方法和图形表示。
■EA已被支持作为MRC/NIHR试验方法学研究伙伴关系中癌症研究所博士研究生的一部分进行这项工作。AM由皇家马斯登NHS基金会信托基金的国家健康研究所(NIHR)生物医学研究中心支持,癌症研究所和帝国理工学院。
UNASSIGNED: Traditionally, within dose-finding clinical trials, treatment toxicity and tolerability are assessed by clinicians. Research has shown that clinician reporting may have inadequate inter-rater reliability, poor correlation with patient reported outcomes, and under capture the true toxicity burden. The introduction of patient-reported outcomes (PROs), where the patient can assess their own symptomatic adverse events or quality of life, has potential to complement current practice to aid dose optimisation. There are no international recommendations offering guidance for the inclusion of PROs in dose-finding trial design and analysis. Our
review aimed to identify and describe current statistical methods and data visualisation techniques employed to analyse and visualise PRO data in published early phase dose-finding oncology trials (DFOTs).
UNASSIGNED: DFOTs published from June 2016-December 2022, which presented PRO analysis methods, were included in this methodological
review. We extracted 35 eligible papers indexed in PubMed. Study characteristics extracted included: PRO objectives, PRO measures, statistical analysis and visualisation techniques, and whether the PRO was involved in interim and final dose selection decisions.
UNASSIGNED: Most papers (30, 85.7%) did not include clear PRO objectives. 20 (57.1%) papers used inferential statistical techniques to analyse PROs, including survival analysis and mixed-effect models. One trial used PROs to classify a clinicians\' assessed dose-limiting toxicities (DLTs). Three (8.6%) trials used PROs to confirm the tolerability of the recommended dose. 25 trial reports visually presented PRO data within a figure or table within their publication, of which 12 papers presented PRO score longitudinally.
UNASSIGNED: This
review highlighted that the statistical methods and reporting of PRO analysis in DFOTs are often poorly described and inconsistent. Many trials had PRO objectives which were not clearly described, making it challenging to evaluate the appropriateness of the statistical techniques used. Drawing conclusions based on DFOTs which are not powered for PROs may be misleading. With no guidance and standardisation of analysis methods for PROs in early phase DFOTs, it is challenging to compare study findings across trials. Therefore, there is a crucial need to establish international guidance to enhance statistical methods and graphical presentation for PRO analysis in the dose-finding setting.
UNASSIGNED: EA has been supported to undertake this work as part of a PhD studentship from the Institute of Cancer Research within the MRC/NIHR Trials Methodology Research Partnership. AM is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust, the Institute of Cancer Research and Imperial College.