Semi-parametric bayesian model, applications in dose finding studies

Abstract : Phase I clinical trials is an area in which statisticians have much to contribute. For over 30 years, this field has benefited from increasing interest on the part of statisticians and clinicians alike and several methods have been proposed to manage the sequential inclusion of patients to a study. The main purpose is to evaluate the occurrence of dose limiting toxicities for a selected group of patients with, typically, life threatening disease. The goal is to maximize the potential for therapeutic success in a situation where toxic side effects are inevitable and increase with increasing dose. From a range of given doses, we aim to determine the dose with a rate of toxicity as close as possible to some threshold chosen by the investigators. This dose is called the MTD (maximum tolerated dose). The standard situation is where we have a finite range of doses ordered with respect to the probability of toxicity at each dose. In this thesis we introduce a very general approach to modeling the problem - SPM (semi-parametric methods) - and these include a large class of methods. The viewpoint of SPM allows us to see things in, arguably, more relevant terms and to provide answers to questions such as asymptotic behavior. What kind of behavior should we be aiming for? For instance, can we consistently estimate the MTD? How, and under which conditions? Different parametrizations of SPM are considered and studied theoretically and via simulations. The obtained performances are comparable, and often better, to those of currently established methods. We extend the findings to the case of partial ordering in which more than one drug is under study and we do not necessarily know how all drug pairs are ordered. The SPM model structure leans on a hierarchical set-up whereby certain parameters are linearly constrained. The theoretical aspects of this structure are outlined for the case of distributions with discrete support. In this setting the great majority of laws can be easily considered and this enables us to avoid over restrictive specifications than can results in poor behavior.
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Matthieu Clertant. Semi-parametric bayesian model, applications in dose finding studies. Statistics [math.ST]. Université Pierre et Marie Curie - Paris VI, 2016. English. ⟨NNT : 2016PA066230⟩. ⟨tel-01822162⟩

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