ProBio: Assessing Operating Characteristics via Simulations

October 9, 2018

Alessio Crippa
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet

Outline


  • Changes in the parameters of the simulation design
    • prevalences of diseases subtypes (biomarkers subtypes)
    • current clinical practice for percentage composition in the control group
    • graduation criteria (\( n_{xk} \ge 5 \) for evaluating \( p_{xk} \ge 20 \))
Enzalutamide  Abiraterone   Radium 223  Cabazitaxel    Docetaxel 
          39           20            6            1           34 
  • Updated results

Prevalences of diseases subtypes and signatures

   ARA DRD TP53 TEfus   prev
1    -   -    -     - 0.3238
2    -   -    -     + 0.0667
3    -   -    +     - 0.1714
4    -   -    +     + 0.1143
5    -   +    -     - 0.0667
6    -   +    -     + 0.0476
7    -   +    +     - 0.0190
8    -   +    +     + 0.0095
9    +   -    -     - 0.0476
10   +   -    -     + 0.0381
11   +   -    +     - 0.0095
12   +   -    +     + 0.0381
13   +   +    -     - 0.0286
14   +   +    -     + 0.0095
15   +   +    +     - 0.0095
   signatures ---- ---+ --+- --++ -+-- -+-+ -++- -+++ +--- +--+ +-+- +-++ ++-- ++-+ +++-   n prev
1         all    X    X    X    X    X    X    X    X    X    X    X    X    X    X    X 105 1.00
2 TP53- & AR-    X    X              X    X                                               53 0.50
3 TP53+ | AR+              X    X              X    X    X    X    X    X    X    X    X  52 0.50
4        DRD+                        X    X    X    X                        X    X    X  20 0.19
5        DRD-    X    X    X    X                        X    X    X    X                 85 0.81
6      TEfus+         X         X         X         X         X         X         X       34 0.32
7      TEfus-    X         X         X         X         X         X         X         X  71 0.68

Assumed progression free survival times

\( T_{ixk} \sim Weibull(\textrm{shape} = 2, \textrm{scale}_{xk}) \)
\( i = 1, \dots, n_{xk}, \;\; \) \( x = 2, \dots, 6 \; \) \( k = 1, \dots, 15 \)

Mean PFS: 5.3 months for an ineffective treatment (median 5)

Mean PFS: 13.3 months for an effective treatment, HR: 2 (median 12.5)

Waiting for more data

Overlapping individuals

     Control Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
----     223            2          46         51          74        90
---+      32           23           2         15          27         1
--+-     102           34          11         79           4        14
--++      57            7          32          2          22        37
-+--      33           21           4          9           7        21
-+-+      20           11           3          7           9         5
-++-      13            4           3          2           7         1
-+++       2            2           2          1           2         0
+---      25           17           3         13           6         4
+--+      15            8           6          2          20        13
+-+-       8            4           4          1           3         2
+-++      16            6          18          3           9         1
++--       9            8           4          0           5         4
++-+       6            2           2          3           3         0
+++-       2            4           0          3           1         1
            Control Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all             563          153         140        191         199       194
TP53- & AR-     308           57          55         82         117       117
TP53+ | AR+     255           96          85        109          82        77
DRD+             85           52          18         25          34        32
DRD-            478          101         122        166         165       162
TEfus+          148           59          65         33          92        57
TEfus-          415           94          75        158         107       137

Analyses

\[ \begin{cases} \log(T, x) = \beta_{01} + \beta_{11}trt + \sigma W \\ \log(T, x) = \beta_{02} + \beta_{12}trt + \beta_{22}(\text{TP53}_- \text{& AR}_-) + \beta_{32}(trt\cdot \text{TP53}_- \text{& AR}_-) + \sigma W \\ \log(T, x) = \beta_{03} + \beta_{13}trt + \beta_{23}\text{DRD}_+ + \beta_{33}(trt\cdot \text{DRD}_+) + \sigma W \\ \log(T, x) = \beta_{04} + \beta_{14}trt + \beta_{24}\text{TEfus}_+ + \beta_{34}(trt\cdot \text{TEfus}_+) + \sigma W \end{cases} \]

Put a common prior on the \( \beta_{i3} \), \( i = 2, 3, 4 \)

Results 1: No treatment effective in any subtype


True mean PF times

     Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
----          5.3         5.3        5.3         5.3       5.3
---+          5.3         5.3        5.3         5.3       5.3
--+-          5.3         5.3        5.3         5.3       5.3
--++          5.3         5.3        5.3         5.3       5.3
-+--          5.3         5.3        5.3         5.3       5.3
-+-+          5.3         5.3        5.3         5.3       5.3
-++-          5.3         5.3        5.3         5.3       5.3
-+++          5.3         5.3        5.3         5.3       5.3
+---          5.3         5.3        5.3         5.3       5.3
+--+          5.3         5.3        5.3         5.3       5.3
+-+-          5.3         5.3        5.3         5.3       5.3
+-++          5.3         5.3        5.3         5.3       5.3
++--          5.3         5.3        5.3         5.3       5.3
++-+          5.3         5.3        5.3         5.3       5.3
+++-          5.3         5.3        5.3         5.3       5.3

Average Number of Participants by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                  193         191        192         192       190
TP53- & AR-           95          98        100          94        97
TP53+ | AR+           98          93         92          98        93
DRD+                  37          36         36          38        36
DRD-                 155         155        155         155       154
TEfus+                63          62         62          64        60
TEfus-               129         129        129         129       130

Graduation Probabilities

             p1    p2
Enzalutamide  0 0.045
Abiraterone   0 0.030
Radium.223    0 0.050
Cabazitaxel   0 0.070
Docetaxel     0 0.040

Graduation Times by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                   24          24         24          24        24
TP53- & AR-           24          24         24          24        24
TP53+ | AR+           24          24         24          24        24
DRD+                  24          24         24          24        24
DRD-                  24          24         24          24        24
TEfus+                24          24         24          24        24
TEfus-                24          24         24          24        24

Probability of superiority by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.094       0.087      0.095       0.078     0.053
TP53- & AR-        0.200       0.192      0.207       0.177     0.150
TP53+ | AR+        0.098       0.094      0.099       0.090     0.069
DRD+               0.109       0.110      0.111       0.111     0.114
DRD-               0.177       0.180      0.203       0.166     0.116
TEfus+             0.124       0.137      0.133       0.118     0.111
TEfus-             0.146       0.132      0.147       0.129     0.091

Results 1: No treatment effective in any subtype

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.000        0.00      0.000       0.000     0.000
TP53- & AR-        0.040        0.02      0.015       0.045     0.025
TP53+ | AR+        0.000        0.00      0.000       0.000     0.000
DRD+               0.000        0.00      0.000       0.000     0.000
DRD-               0.000        0.01      0.030       0.025     0.025
TEfus+             0.000        0.00      0.000       0.000     0.000
TEfus-             0.005        0.00      0.005       0.005     0.000

Results 2: Abiraterone effective in all subtypes, other treatments ineffective


True mean PF times

     Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
----          5.3          13        5.3         5.3       5.3
---+          5.3          13        5.3         5.3       5.3
--+-          5.3          13        5.3         5.3       5.3
--++          5.3          13        5.3         5.3       5.3
-+--          5.3          13        5.3         5.3       5.3
-+-+          5.3          13        5.3         5.3       5.3
-++-          5.3          13        5.3         5.3       5.3
-+++          5.3          13        5.3         5.3       5.3
+---          5.3          13        5.3         5.3       5.3
+--+          5.3          13        5.3         5.3       5.3
+-+-          5.3          13        5.3         5.3       5.3
+-++          5.3          13        5.3         5.3       5.3
++--          5.3          13        5.3         5.3       5.3
++-+          5.3          13        5.3         5.3       5.3
+++-          5.3          13        5.3         5.3       5.3

Average Number of Participants by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                  201          75        201         200       201
TP53- & AR-          102          41        105         100       104
TP53+ | AR+           99          34         97          99        97
DRD+                  43          14         42          42        42
DRD-                 159          60        159         157       160
TEfus+                66          23         66          67        67
TEfus-               135          52        135         132       134

Graduation Probabilities

               p1    p2
Enzalutamide 0.00 0.015
Abiraterone  0.81 0.000
Radium.223   0.00 0.000
Cabazitaxel  0.00 0.005
Docetaxel    0.00 0.000

Graduation Times by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                   24         9.3         24          24        24
TP53- & AR-           23        20.7         23          23        24
TP53+ | AR+           24        22.5         24          24        24
DRD+                  24        24.0         24          24        24
DRD-                  24         7.3         24          24        24
TEfus+                24        24.0         24          24        24
TEfus-                24        13.0         24          24        24

Probability of superiority by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.018        0.86      0.016       0.016     0.021
TP53- & AR-        0.078        0.92      0.061       0.062     0.079
TP53+ | AR+        0.037        0.65      0.037       0.037     0.035
DRD+               0.068        0.47      0.082       0.080     0.070
DRD-               0.051        0.94      0.046       0.036     0.056
TEfus+             0.065        0.68      0.056       0.053     0.062
TEfus-             0.040        0.85      0.040       0.041     0.044

Results 2: Abiraterone effective in all subtypes, other treatments ineffective

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.000       0.810          0       0.000         0
TP53- & AR-        0.015       0.230          0       0.005         0
TP53+ | AR+        0.000       0.095          0       0.000         0
DRD+               0.000       0.005          0       0.000         0
DRD-               0.000       0.900          0       0.000         0
TEfus+             0.000       0.010          0       0.000         0
TEfus-             0.000       0.610          0       0.000         0

Results 3: Abiraterone effective for TP53- & AR (prev = 0.50), other treatments ineffective


True mean PF times

     Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
----          5.3        13.3        5.3         5.3       5.3
---+          5.3        13.3        5.3         5.3       5.3
--+-          5.3         5.3        5.3         5.3       5.3
--++          5.3         5.3        5.3         5.3       5.3
-+--          5.3        13.3        5.3         5.3       5.3
-+-+          5.3        13.3        5.3         5.3       5.3
-++-          5.3         5.3        5.3         5.3       5.3
-+++          5.3         5.3        5.3         5.3       5.3
+---          5.3         5.3        5.3         5.3       5.3
+--+          5.3         5.3        5.3         5.3       5.3
+-+-          5.3         5.3        5.3         5.3       5.3
+-++          5.3         5.3        5.3         5.3       5.3
++--          5.3         5.3        5.3         5.3       5.3
++-+          5.3         5.3        5.3         5.3       5.3
+++-          5.3         5.3        5.3         5.3       5.3

Average Number of Participants by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                  199         120        200         199       199
TP53- & AR-           98          54        104         102       101
TP53+ | AR+          101          66         96          97        98
DRD+                  41          18         42          40        40
DRD-                 158         102        159         158       158
TEfus+                65          43         64          64        65
TEfus-               134          77        136         134       134

Graduation Probabilities

               p1    p2
Enzalutamide 0.00 0.025
Abiraterone  0.94 0.055
Radium.223   0.00 0.010
Cabazitaxel  0.00 0.000
Docetaxel    0.00 0.005

Graduation Times by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                   24        20.7         24          24        24
TP53- & AR-           24         8.5         24          24        24
TP53+ | AR+           24        24.0         24          24        24
DRD+                  24        24.0         24          24        24
DRD-                  24        17.4         24          24        24
TEfus+                24        23.9         24          24        24
TEfus-                24        14.7         24          24        24

Probability of superiority by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.038        0.48      0.035       0.034     0.033
TP53- & AR-        0.073        0.95      0.077       0.077     0.057
TP53+ | AR+        0.075        0.11      0.068       0.069     0.080
DRD+               0.087        0.29      0.099       0.088     0.089
DRD-               0.092        0.65      0.072       0.079     0.081
TEfus+             0.080        0.42      0.071       0.079     0.076
TEfus-             0.077        0.53      0.079       0.073     0.073

Results 3: Abiraterone effective for TP53- & AR (prev = 0.50), other treatments ineffective

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.000       0.185       0.00           0     0.000
TP53- & AR-        0.025       0.935       0.01           0     0.005
TP53+ | AR+        0.000       0.000       0.00           0     0.000
DRD+               0.000       0.000       0.00           0     0.000
DRD-               0.000       0.370       0.00           0     0.000
TEfus+             0.000       0.015       0.00           0     0.000
TEfus-             0.000       0.530       0.00           0     0.000

Results 4: Mixed of effective treatments


True mean PF times

     Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
----         10.6        10.6        5.3         5.3       5.3
---+         10.6        10.6        5.3         5.3      13.3
--+-          5.3         5.3        5.3         5.3       5.3
--++          5.3         5.3        5.3         5.3      13.3
-+--         10.6        10.6        5.3         5.3       5.3
-+-+         10.6        10.6        5.3         5.3      13.3
-++-          5.3         5.3        5.3         5.3       5.3
-+++          5.3         5.3        5.3         5.3      13.3
+---          5.3         5.3        5.3         5.3       5.3
+--+          5.3         5.3        5.3         5.3      13.3
+-+-          5.3         5.3        5.3         5.3       5.3
+-++          5.3         5.3        5.3         5.3      13.3
++--          5.3         5.3        5.3         5.3       5.3
++-+          5.3         5.3        5.3         5.3      13.3
+++-          5.3         5.3        5.3         5.3       5.3

Average Number of Participants by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                  165         168        184         186       162
TP53- & AR-           74          72         88          89        69
TP53+ | AR+           91          96         96          97        93
DRD+                  28          29         46          45        35
DRD-                 137         139        138         141       127
TEfus+                52          54         73          73        56
TEfus-               113         113        111         113       106

Graduation Probabilities

               p1    p2
Enzalutamide 0.95 0.005
Abiraterone  0.95 0.000
Radium.223   0.00 0.000
Cabazitaxel  0.00 0.000
Docetaxel    0.97 0.000

Graduation Times by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                   24        24.0         24          24        24
TP53- & AR-           10         9.9         24          24        23
TP53+ | AR+           24        24.0         24          24        23
DRD+                  24        23.9         24          24        24
DRD-                  24        23.8         24          24        24
TEfus+                24        24.0         24          24        12
TEfus-                23        23.6         24          24        24

Probability of superiority by Signature

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.098       0.108      0.014       0.011      0.58
TP53- & AR-        0.469       0.469      0.051       0.050      0.47
TP53+ | AR+        0.048       0.048      0.040       0.033      0.61
DRD+               0.160       0.182      0.073       0.056      0.30
DRD-               0.168       0.167      0.035       0.036      0.74
TEfus+             0.080       0.083      0.029       0.019      0.95
TEfus-             0.284       0.301      0.073       0.062      0.08

Results 4: Mixed of effective treatments

            Enzalutamide Abiraterone Radium 223 Cabazitaxel Docetaxel
all                0.000       0.000          0           0     0.005
TP53- & AR-        0.955       0.955          0           0     0.095
TP53+ | AR+        0.000       0.000          0           0     0.040
DRD+               0.000       0.005          0           0     0.000
DRD-               0.000       0.010          0           0     0.040
TEfus+             0.000       0.000          0           0     0.975
TEfus-             0.045       0.025          0           0     0.000

Effectiveness vs Efficacy

Based on one simulated dataset from scenario 4

\[ h(t, x) = h_0(t) exp(trt + sign2 + trt\cdot sign2) \]

                              exp(Est.) 2.5% 97.5%
trtEnzalutamide                    1.82 1.37  2.43
trtAbiraterone                     1.31 0.95  1.80
trtRadium 223                      1.37 1.08  1.74
trtCabazitaxel                     1.65 1.26  2.17
trtDocetaxel                       0.53 0.40  0.71
`TP53- & AR-`                      0.86 0.70  1.06
trtEnzalutamide:`TP53- & AR-`      0.33 0.22  0.51
trtAbiraterone:`TP53- & AR-`       0.41 0.26  0.65
trtRadium 223:`TP53- & AR-`        1.24 0.86  1.79
trtCabazitaxel:`TP53- & AR-`       1.28 0.89  1.84
trtDocetaxel:`TP53- & AR-`         3.57 2.46  5.18

Contrasts (adjusting for multicomparison)


     Simultaneous Tests for General Linear Hypotheses

Fit: coxph(formula = Surv(time_m, delta) ~ trt * `TP53- & AR-`, data = s_dta)

Linear Hypotheses:
                   Estimate Std. Error z value Pr(>|z|)    
Enz - ctr (0) == 0   0.6003     0.1458    4.12   0.0010 ** 
Abi - ctr (0) == 0   0.2675     0.1645    1.63   0.8173    
Rad - ctr (0) == 0   0.3144     0.1233    2.55   0.2007    
Cab - ctr (0) == 0   0.5029     0.1393    3.61   0.0080 ** 
Doc - ctr (0) == 0  -0.6277     0.1449   -4.33   <0.001 ***
Abi - Enz (0) == 0  -0.3328     0.1915   -1.74   0.7477    
Rad - Enz (0) == 0  -0.2859     0.1587   -1.80   0.7035    
Cab - Enz (0) == 0  -0.0974     0.1707   -0.57   0.9999    
Doc - Enz (0) == 0  -1.2281     0.1799   -6.83   <0.001 ***
Rad - Abi (0) == 0   0.0469     0.1761    0.27   1.0000    
Cab - Abi (0) == 0   0.2354     0.1871    1.26   0.9607    
Doc - Abi (0) == 0  -0.8953     0.1952   -4.59   <0.001 ***
Cab - Rad (0) == 0   0.1885     0.1528    1.23   0.9658    
Doc - Rad (0) == 0  -0.9422     0.1612   -5.85   <0.001 ***
Doc - Cab (0) == 0  -1.1307     0.1743   -6.49   <0.001 ***
Enz - ctr (1) == 0  -0.5012     0.1627   -3.08   0.0479 *  
Abi - ctr (1) == 0  -0.6166     0.1586   -3.89   0.0027 ** 
Rad - ctr (1) == 0   0.5311     0.1418    3.74   0.0049 ** 
Cab - ctr (1) == 0   0.7512     0.1251    6.01   <0.001 ***
Doc - ctr (1) == 0   0.6443     0.1216    5.30   <0.001 ***
Abi - Enz (1) == 0  -0.1153     0.1980   -0.58   0.9999    
Rad - Enz (1) == 0   1.0323     0.1890    5.46   <0.001 ***
Cab - Enz (1) == 0   1.2525     0.1771    7.07   <0.001 ***
Doc - Enz (1) == 0   1.1456     0.1736    6.60   <0.001 ***
Rad - Abi (1) == 0   1.1477     0.1861    6.17   <0.001 ***
Cab - Abi (1) == 0   1.3678     0.1740    7.86   <0.001 ***
Doc - Abi (1) == 0   1.2609     0.1701    7.41   <0.001 ***
Cab - Rad (1) == 0   0.2201     0.1540    1.43   0.9110    
Doc - Rad (1) == 0   0.1132     0.1519    0.75   0.9994    
Doc - Cab (1) == 0  -0.1069     0.1364   -0.78   0.9990    
---
Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Adjusted p values reported -- single-step method)

Estimated effect sizes

              exp(Est.) 2.5% 97.5%
Enz - ctr (0)      1.82 1.37  2.43
Abi - ctr (0)      1.31 0.95  1.80
Rad - ctr (0)      1.37 1.08  1.74
Cab - ctr (0)      1.65 1.26  2.17
Doc - ctr (0)      0.53 0.40  0.71
Abi - Enz (0)      0.72 0.49  1.04
Rad - Enz (0)      0.75 0.55  1.03
Cab - Enz (0)      0.91 0.65  1.27
Doc - Enz (0)      0.29 0.21  0.42
Rad - Abi (0)      1.05 0.74  1.48
Cab - Abi (0)      1.27 0.88  1.83
Doc - Abi (0)      0.41 0.28  0.60
Cab - Rad (0)      1.21 0.89  1.63
Doc - Rad (0)      0.39 0.28  0.53
Doc - Cab (0)      0.32 0.23  0.45
Enz - ctr (1)      0.61 0.44  0.83
Abi - ctr (1)      0.54 0.40  0.74
Rad - ctr (1)      1.70 1.29  2.25
Cab - ctr (1)      2.12 1.66  2.71
Doc - ctr (1)      1.90 1.50  2.42
Abi - Enz (1)      0.89 0.60  1.31
Rad - Enz (1)      2.81 1.94  4.07
Cab - Enz (1)      3.50 2.47  4.95
Doc - Enz (1)      3.14 2.24  4.42
Rad - Abi (1)      3.15 2.19  4.54
Cab - Abi (1)      3.93 2.79  5.52
Doc - Abi (1)      3.53 2.53  4.92
Cab - Rad (1)      1.25 0.92  1.69
Doc - Rad (1)      1.12 0.83  1.51
Doc - Cab (1)      0.90 0.69  1.17