Abstract
Analyzing and effectively communicating the efficacy and toxicity of treatment is the fundamental basis of risk-benefit analysis (RBA). There is a need for more efficient and objective tools. We apply Chauhan Weighted Trajectory Analysis (CWTA) to perform RBA with superior objectivity, power, and ease of communication. We used CWTA to perform 1000-fold simulations of RCTs using ordinal endpoints that captured both treatment efficacy and treatment toxicity. RCTs were stochastically generated with 1:1 allocation at defined sample sizes and hazard ratios. We first studied the simplest case simulation of 3 levels each of toxicity and efficacy (a 3 × 3 matrix). We then simulated the general case of the advanced cancer trial, with efficacy graded by five RECIST 1.1 health statuses and toxicity graded by the six-point CTCAE scale to create a 6 × 5 matrix. Finally, the 6 × 5 matrix model was applied to a real-world dose escalation phase I trial in advanced cancer. Simulations in both the 3 × 3 simplest case matrix and the 6 × 5 advanced cancer matrix confirmed our hypothesis that drugs with both superior efficacy and toxicity profiles synergize for greater statistical power with CWTA RBA than either signal alone. The CWTA RBA 6 × 5 matrix meaningfully reduced sample size requirements over CWTA efficacy-only analysis. Despite a small sample size, application of the matrix to each of the seven cohorts of the dose finding phase I clinical trial provided objective and statistically significant validation for the dose subjectively selected by the trialists. CWTA RBA, by incorporating both drug efficacy and the trajectory of drug toxicity, provides a single test statistic and summary plot that analyzes, visualizes, and effectively communicates the risk-benefit assessment of a clinical trial. CWTA RBA requires fewer patients than CWTA efficacy-only analysis when the experimental drug is both more effective and less toxic. Our results show CWTA RBA has the potential to aid the objective and efficient assessment of new therapies throughout the drug development pathway. Furthermore, its distinct advantages over competing tests in visualizing and communicating risk-benefit will assist regulatory review, clinical adoption, and understanding of therapeutic risks and benefits by clinicians and patients alike.