title: Efficiency of new dose escalation designs in dose-finding phase I trials of molecularly targeted agents.
abstract: BACKGROUND
  Statistical simulations have consistently demonstrated that new dose-escalation designs such as accelerated titration design (ATD) and continual reassessment method (CRM)-type designs outperform the standard "3+3" design in phase I cancer clinical trials.
  
  
  METHODS
  We evaluated the actual efficiency of different dose escalation methods employed in first-in-human phase I clinical trials of targeted agents administered as single agents published over the last decade.
  
  
  RESULTS
  Forty-nine per cent of the 84 retrieved trials used the standard "3+3" design. Newer designs used included ATD in 42%, modified CRM [mCRM] in 7%, and pharmacologically guided dose escalation in 1%. The median numbers of dose levels explored in trials using "3+3", ATD and mCRM designs were 6, 8 and 10, respectively. More strikingly, the mean MTD to starting dose ratio appeared to be at least twice as high for trials using mCRM or ATD designs as for trials using a standard "3+3" design. Despite this, the mean number of patients exposed to a dose below the MTD was similar in trials using "3+3", ATD and mCRM designs.
  
  
  CONCLUSIONS
  Our results support a more extensive implementation of innovative dose escalation designs such as mCRM and ATD in phase I cancer clinical trials of molecularly targeted agents.
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France. Christophe.LeTourneau@curie.net
authors.forename: Christophe
authors.initials: C
authors.lastname: Le Tourneau
authors.forename: Hui K
authors.initials: HK
authors.lastname: Gan
authors.forename: Albiruni R A
authors.initials: AR
authors.lastname: Razak
authors.forename: Xavier
authors.initials: X
authors.lastname: Paoletti
mesh_terms: D000465:Algorithms; D017321:Clinical Trials, Phase I as Topic; D004305:Dose-Response Relationship, Drug; D006801:Humans; D020714:Maximum Tolerated Dose; D015233:Models, Statistical; D009369:Neoplasms / Q000188:drug therapy*; D012107:Research Design