The New England Journal of Statistics in Data Science

In oncology therapy development, Simon’s two-stage design is commonly employed in early-phase clinical trials to assess the preliminary efficacy of a single dose, typically the maximum tolerable dose (MTD) or the maximum assessed dose (MAD). In this design, a dose may be terminated at the first stage if the anti-tumor activity is insufficient or it may proceed to the second stage for further evaluation with more subjects. To enhance the design for better benefit-risk profile dose selection and to meet the increasing needs for study designs that explore dose-response relationships, we extend Simon’s two-stage design to evaluate two doses and to include early termination for success in addition to futility. The proposed method derives decision rules and sample sizes for optimal study designs that minimize the expected or overall sample sizes while controlling type I error and meeting desired power.