title: Statistical controversies in clinical research: early-phase adaptive design for combination immunotherapies.
abstract: In recent years, investigators have asserted that the 3 + 3 design lacks flexibility, making its use in modern early-phase trial settings, such as combinations and/or biological agents, inefficient. More innovative approaches are required to address contemporary research questions, such as those posed in trials involving immunotherapies.
  
  
  
  We describe the implementation of an adaptive design for identifying an optimal treatment regimen, defined by low toxicity and high immune response, in an early-phase trial of a melanoma helper peptide vaccine plus novel adjuvant combinations.
  
  
  
  Operating characteristics demonstrate the ability of the method to effectively recommend optimal regimens in a high percentage of trials with reasonable sample sizes.
  
  
  
  The proposed design is a practical, early-phase, adaptive method for use with combined immunotherapy regimens. This design can be applied more broadly to early-phase combination studies, as it was used in an ongoing study of two small molecule inhibitors in relapsed/refractory mantle cell lymphoma.
authors.affiliation: Department of Public Health Sciences, Division of Translational Research & Applied Statistics, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Wages
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Slingluff
authors.affiliation: Department of Public Health Sciences, Division of Translational Research & Applied Statistics, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Petroni
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000951:Antigens, Neoplasm / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D035843:Biomedical Research / Q000379:methods*; D019496:Cancer Vaccines / Q000627:therapeutic use*; D006801:Humans; D008545:Melanoma / Q000628:therapy*; D012107:Research Design; D013223:Statistics as Topic
chemical_list: D000276:Adjuvants, Immunologic; D000951:Antigens, Neoplasm; D019496:Cancer Vaccines
keywords: clinical trials; combination; early-phase; immunotherapy; melanoma