Combined criteria for dose optimisation in early phase clinical trials

This paper aims to investigate whether any bridge is possible between so-called best intention and D-optimum designs. It introduces combined criteria for dose optimisation in seamless phase I/II adaptive clinical trials. Each of the optimality criteria considers efficacy and toxicity as endpoints and is based on the probability of a successful outcome and on the determinant of the Fisher information matrix for estimation of the dose-response parameters. In addition, one of the criteria incorporates penalties for choosing a toxic or inefficacious dose. Starting with the lowest dose, the adaptive design selects the dose for each subsequent cohort that maximises the respective defined criterion. The methodology is illustrated with a dose-response model that assumes trinomial responses. Simulation studies show that the method is capable of identifying the optimal dose accurately without exposing many patients to toxic doses.