DROID: Dose-Ranging Approach to Optimizing Dose in Oncology Drug Development

Authors

Beibei Guo
Ying Yuan

Publication Date

12-1-2023

Journal

Biometrics

Abstract

In the era of targeted therapy, there has been increasing concern about the development of oncology drugs based on the "more is better" paradigm, developed decades ago for chemotherapy. Recently, the US Food and Drug Administration (FDA) initiated Project Optimus to reform the dose optimization and dose selection paradigm in oncology drug development. To accommodate this paradigm shifting, we propose a dose-ranging approach to optimizing dose (DROID) for oncology trials with targeted drugs. DROID leverages the well-established dose-ranging study framework, which has been routinely used to develop non-oncology drugs for decades, and bridges it with established oncology dose-finding designs to optimize the dose of oncology drugs. DROID consists of two seamlessly connected stages. In the first stage, patients are sequentially enrolled and adaptively assigned to investigational doses to establish the therapeutic dose range (TDR), defined as the range of doses with acceptable toxicity and efficacy profiles, and the recommended phase 2 dose set (RP2S). In the second stage, patients are randomized to the doses in RP2S to assess the dose-response relationship and identify the optimal dose. The simulation study shows that DROID substantially outperforms the conventional approach, providing a new paradigm to efficiently optimize the dose of targeted oncology drugs. DROID aligns with the approach of a randomized, parallel dose-response trial design recommended by the FDA in the Guidance on Optimizing the Dosage of Human Prescription Drugs and Biological Products for the Treatment of Oncologic Diseases.

Keywords

Humans, Neoplasms, Computer Simulation, Drug Development, Dose-Response Relationship, Drug, Antineoplastic Agents, Research Design, dose-response relationship, maximum tolerated dose, optimal dose, risk-benefit assessment, targeted drugs

DOI

10.1111/biom.13840

PMID

36807110

PMCID

PMC11713780

PubMedCentral® Posted Date

1-9-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes