Clinical Research Papers:
Predictors of early treatment discontinuation in patients enrolled on Phase I oncology trials
Metrics: PDF 2086 views | HTML 2051 views | ?
David M. Hyman1,4,*, Anne A. Eaton2,*, Mrinal M. Gounder1,4, Erika G. Pamer1, Jasmine Pettiford1, Richard D. Carvajal1,4, S. Percy Ivy3, Alexia Iasonos2,4, David R. Spriggs1,4
1Developmental Therapeutics, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
3The National Cancer Institute, Bethesda, MD 20892, USA
4Weill Cornell Medical College, New York, NY 10065, USA
*These authors have contributed equally to this work
David M. Hyman, e-mail: [email protected]
Keywords: Phase I trials, Early Discontinuation, Drug Development
Received: October 21, 2014 Accepted: December 11, 2014 Published: February 17, 2015
Patients who do not complete one cycle of therapy on Phase I trials for reasons other than dose limiting toxicity (DLT) are considered inevaluable for toxicity and must be replaced.
Individual records from patients enrolled to NCI-sponsored Phase I trials activated between 2000 and 2010 were used. Early discontinuation was defined as the failure to begin cycle 2 for reasons other than a DLT during cycle 1. A multinomial logistic regression with a 3-level nominal outcome (early discontinuation, DLT during cycle 1, and continuation to cycle 2) was used with continuation to cycle 2 serving as the reference category. The final model was used to create two risk scores. An independent external cohort was used to validate these models.
Data from 3079 patients on 127 Phase I trials were analyzed. ECOG performance status (1, ≥ 2, two-sided P = .0315 and P = .0007), creatinine clearance (<60 ml/min, P = .0455), alkaline phosphatase (>2.5xULN, P = .0026), AST (>ULN, P = .0076), hemoglobin (<10 g/dL, P < .0001), albumin (<3.5 g/dL, P < .0001), and platelets (<400x109/L, P = .0732) were predictors of early discontinuation. The c-index of the final model was 0.63.
Knowledge of risk factors for early treatment discontinuation in conjunction with clinical judgment can help guide Phase I patient selection.
All site content, except where otherwise noted, is licensed under a Creative Commons Attribution 4.0 License.