Controlled experiments are widely applied in many areas such as clinical trials or user behavior studies in IT companies. Recently, it is popular to study experimental design problems to facilitate personalized decision making. In this paper, we investigate the problem of optimal design of multiple treatment allocation for personalized decision making in the presence of observational covariates associated with experimental units (often, patients or users). We assume that the response of a subject assigned to a treatment follows a linear model which includes the interaction between covariates and treatments to facilitate precision decision making. We define the optimal objective as the maximum variance of estimated personalized treatment effects over different treatments and different covariates values. The optimal design is obtained by minimizing this objective. Under a semi-definite program reformulation of the original optimization problem, we use a YALMIP and MOSEK based optimization solver to provide the optimal design. Numerical studies are provided to assess the quality of the optimal design.
more »
« less
Min-Max Optimal Design of Two-Armed Trials with Side Information
In this work, we study the optimal design of two-armed clinical trials to maximize the accuracy of parameter estimation in a statistical model, where the interaction between patient covariates and treatment are explicitly incorporated to enable precision medication decisions. Such a modeling extension leads to significant complexities for the produced optimization problems because they include optimization over design and covariates concurrently. We take a min-max optimization model and minimize (over design) the maximum (over population) variance of the estimated interaction effect between treatment and patient covariates. This results in a min-max bilevel mixed integer nonlinear programming problem, which is notably challenging to solve. To address this challenge, we introduce a surrogate optimization model by approximating the objective function, for which we propose two solution approaches. The first approach provides an exact solution based on reformulation and decomposition techniques. In the second approach, we provide a lower bound for the inner optimization problem and solve the outer optimization problem over the lower bound. We test our proposed algorithms with synthetic and real-world data sets and compare them with standard (re)randomization methods. Our numerical analysis suggests that the proposed approaches provide higher-quality solutions in terms of the variance of estimators and probability of correct selection. We also show the value of covariate information in precision medicine clinical trials by comparing our proposed approaches to an alternative optimal design approach that does not consider the interaction terms between covariates and treatment. Summary of Contribution: Precision medicine is the future of healthcare where treatment is prescribed based on each patient information. Designing precision medicine clinical trials, which are the cornerstone of precision medicine, is extremely challenging because sample size is limited and patient information may be multidimensional. This work proposes a novel approach to optimally estimate the treatment effect for each patient type in a two-armed clinical trial by reducing the largest variance of personalized treatment effect. We use several statistical and optimization techniques to produce efficient solution methodologies. Results have the potential to save countless lives by transforming the design and implementation of future clinical trials to ensure the right treatments for the right patients. Doing so will reduce patient risks and reduce costs in the healthcare system.
more »
« less
- Award ID(s):
- 1651912
- NSF-PAR ID:
- 10397879
- Date Published:
- Journal Name:
- INFORMS Journal on Computing
- Volume:
- 34
- Issue:
- 1
- ISSN:
- 1091-9856
- Page Range / eLocation ID:
- 165 to 182
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
A key and challenging step toward personalized/precision medicine is the ability to redesign dose-finding clinical trials. This work studies a problem of fully response-adaptive Bayesian design of phase II dose-finding clinical trials with patient information, where the decision maker seeks to identify the right dose for each patient type (often defined as an effective target dose for each group of patients) by minimizing the expected (over patient types) variance of the right dose. We formulate this problem by a stochastic dynamic program and exploit a few properties of this class of learning problems. Because the optimal solution is intractable, we propose an approximate policy by an adaptation of a one-step look-ahead framework. We show the optimality of the proposed policy for a setting with homogeneous patients and two doses and find its asymptotic rate of sampling. We adapt a number of commonly applied allocation policies in dose-finding clinical trials, such as posterior adaptive sampling, and test their performance against our proposed policy via extensive simulations with synthetic and real data. Our numerical analyses provide insights regarding the connection between the structure of the dose-response curve for each patient type and the performance of allocation policies. This paper provides a practical framework for the Food and Drug Administration and pharmaceutical companies to transition from the current phase II procedures to the era of personalized dose-finding clinical trials. Funding: This research is supported by the National Science Foundation [Grant 1651912]. Supplemental Material: The online appendices are available at https://doi.org/10.1287/serv.2022.0306 .more » « less
-
more » « less
Abstract Precision medicine is the systematic use of information that pertains to an individual patient to select or optimize that patient's preventative and therapeutic care. Recent studies have classified biomarkers into predictive and prognostic biomarkers based on their roles in clinical studies. To design a clinical trial for precision medicine, predictive biomarkers and prognostic biomarkers should both be included. In statistical analysis, biomarkers are mathematically treated as covariates. We first classify covariates into predictive and prognostic covariates according to their roles. We then provide a brief review of recent advances in adaptive designs that incorporate covariates. However, the literature includes no designs that incorporate both prognostic covariates and predictive covariates simultaneously. In this paper, we propose a new family of covariate‐adjusted response‐adaptive (CARA) designs that incorporate both prognostic and predictive covariates and the responses. It is important to note that the predictive biomarkers and prognostic biomarkers play different roles in the new designs. The advantages of the proposed methods are demonstrated via numerical studies, and some further statistical issues are also discussed.
-
more » « less
In precision medicine, the ultimate goal is to recommend the most effective treatment to an individual patient based on patient‐specific molecular and clinical profiles, possibly high‐dimensional. To advance cancer treatment, large‐scale screenings of cancer cell lines against chemical compounds have been performed to help better understand the relationship between genomic features and drug response; existing machine learning approaches use exclusively supervised learning, including penalized regression and recommender systems. However, it would be more efficient to apply reinforcement learning to sequentially learn as data accrue, including selecting the most promising therapy for a patient given individual molecular and clinical features and then collecting and learning from the corresponding data. In this article, we propose a novel personalized ranking system called Proximal Policy Optimization Ranking (PPORank), which ranks the drugs based on their predicted effects per cell line (or patient) in the framework of deep reinforcement learning (DRL). Modeled as a Markov decision process, the proposed method learns to recommend the most suitable drugs sequentially and continuously over time. As a proof‐of‐concept, we conduct experiments on two large‐scale cancer cell line data sets in addition to simulated data. The results demonstrate that the proposed DRL‐based PPORank outperforms the state‐of‐the‐art competitors based on supervised learning. Taken together, we conclude that novel methods in the framework of DRL have great potential for precision medicine and should be further studied.
-
There is tremendous interest in precision medicine as a means to improve patient out- comes by tailoring treatment to individual characteristics. An individualized treatment rule formalizes precision medicine as a map from patient information to a recommended treatment. A treatment rule is defined to be optimal if it maximizes the mean of a scalar outcome in a population of interest, e.g., symptom reduction. However, clinical and intervention scientists often seek to balance multiple and possibly competing outcomes, e.g., symptom reduction and the risk of an adverse event. One approach to precision medicine in this setting is to elicit a composite outcome which balances all competing outcomes; unfortunately, eliciting a composite outcome directly from patients is difficult without a high-quality instrument, and an expert-derived composite outcome may not account for heterogeneity in patient preferences. We propose a new paradigm for the study of precision medicine using observational data that relies solely on the assumption that clinicians are approximately (i.e., imperfectly) making decisions to maximize individual patient utility. Estimated composite outcomes are subsequently used to construct an estimator of an individualized treatment rule which maximizes the mean of patient-specific composite out- comes. The estimated composite outcomes and estimated optimal individualized treatment rule provide new insights into patient preference heterogeneity, clinician behavior, and the value of precision medicine in a given domain. We derive inference procedures for the pro- posed estimators under mild conditions and demonstrate their finite sample performance through a suite of simulation experiments and an illustrative application to data from a study of bipolar depression.more » « less
- Free Publicly Accessible Full Text
-
Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1287/ijoc.2021.1068
