title: Combining biomarkers to optimize patient treatment recommendations.
abstract: Markers that predict treatment effect have the potential to improve patient outcomes. For example, the OncotypeDX® RecurrenceScore® has some ability to predict the benefit of adjuvant chemotherapy over and above hormone therapy for the treatment of estrogen-receptor-positive breast cancer, facilitating the provision of chemotherapy to women most likely to benefit from it. Given that the score was originally developed for predicting outcome given hormone therapy alone, it is of interest to develop alternative combinations of the genes comprising the score that are optimized for treatment selection. However, most methodology for combining markers is useful when predicting outcome under a single treatment. We propose a method for combining markers for treatment selection which requires modeling the treatment effect as a function of markers. Multiple models of treatment effect are fit iteratively by upweighting or "boosting" subjects potentially misclassified according to treatment benefit at the previous stage. The boosting approach is compared to existing methods in a simulation study based on the change in expected outcome under marker-based treatment. The approach improves upon methods in some settings and has comparable performance in others. Our simulation study also provides insights as to the relative merits of the existing methods. Application of the boosting approach to the breast cancer data, using scaled versions of the original markers, produces marker combinations that may have improved performance for treatment selection.
authors.affiliation: Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A.
authors.forename: Chaeryon
authors.initials: C
authors.lastname: Kang
authors.affiliation: Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A.
authors.forename: Holly
authors.initials: H
authors.lastname: Janes
authors.affiliation: Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D001699:Biometry / Q000379:methods*; D001943:Breast Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor
keywords: Biomarker; Boosting; Model mis‐specification; Treatment selection