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Cho SM, Robba C, Diringer MN, Hanley DF, Hemphill JC, Horn J, Lewis A, Livesay SL, Menon D, Sharshar T, Stevens RD, Torner J, Vespa PM, Ziai WC, Spann M, Helbok R, Suarez JI. Optimal Design of Clinical Trials Involving Persons with Disorders of Consciousness. Neurocrit Care 2024; 40:74-80. [PMID: 37535178 DOI: 10.1007/s12028-023-01813-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Limited data exist regarding the optimal clinical trial design for studies involving persons with disorders of consciousness (DoC), and only a few therapies have been tested in high-quality clinical trials. To address this, the Curing Coma Campaign Clinical Trial Working Group performed a gap analysis on the current state of clinical trials in DoC to identify the optimal clinical design for studies involving persons with DoC. METHODS The Curing Coma Campaign Clinical Trial Working Group was divided into three subgroups to (1) review clinical trials involving persons with DoC, (2) identify unique challenges in the design of clinical trials involving persons with DoC, and (3) recommend optimal clinical trial designs for DoC. RESULTS There were 3055 studies screened, and 66 were included in this review. Several knowledge gaps and unique challenges were identified. There is a lack of high-quality clinical trials, and most data regarding patients with DoC are based on observational studies focusing on patients with traumatic brain injury and cardiac arrest. There is a lack of a structured long-term outcome assessment with significant heterogeneity in the methodology, definitions of outcomes, and conduct of studies, especially for long-term follow-up. Another major barrier to conducting clinical trials is the lack of resources, especially in low-income countries. Based on the available data, we recommend incorporating trial designs that use master protocols, sequential multiple assessment randomized trials, and comparative effectiveness research. Adaptive platform trials using a multiarm, multistage approach offer substantial advantages and should make use of biomarkers to assess treatment responses to increase trial efficiency. Finally, sound infrastructure and international collaboration are essential to facilitate the conduct of trials in patients with DoC. CONCLUSIONS Conduct of trials in patients with DoC should make use of master protocols and adaptive design and establish international registries incorporating standardized assessment tools. This will allow the establishment of evidence-based practice recommendations and decrease variations in care.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street , Baltimore, MD, 21287, USA
| | - Chiara Robba
- IRCCS for Oncology and Neuroscience and Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Michael N Diringer
- Departments of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel F Hanley
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street , Baltimore, MD, 21287, USA
| | - J Claude Hemphill
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Ariane Lewis
- Division of Neurocritical Care, Department of Neurology and Neurosurgery, New York University, New York, NY, USA
| | - Sarah L Livesay
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - David Menon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Tarek Sharshar
- Departments of Neurology and Intensive Care Medicine, Paris-Descartes University, Paris, France
| | - Robert D Stevens
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street , Baltimore, MD, 21287, USA
| | - James Torner
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Paul M Vespa
- Departments of Neurology and Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Wendy C Ziai
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street , Baltimore, MD, 21287, USA
| | - Marcus Spann
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street , Baltimore, MD, 21287, USA
| | - Raimund Helbok
- Departments of Neurology and Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Jose I Suarez
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street , Baltimore, MD, 21287, USA.
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Savel H, Meyer-Losic F, Proust-Lima C, Richert L. Statistical classification of treatment responses in mouse clinical trials for stratified medicine in oncology drug discovery. Sci Rep 2024; 14:934. [PMID: 38195626 PMCID: PMC10776864 DOI: 10.1038/s41598-023-51055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Abstract
Translational oncology research strives to explore a new aspect: identifying subgroups that exhibit treatment response even during pre-clinical phases. In this study, we focus on PDX models and their implementation in mouse clinical trials (MCT). Our primary objective was to identify subgroups with different treatment responses using Latent Class Mixed Model (LCMM).We used a public dataset and focused on one treatment, encorafenib, and two indications, melanoma and colorectal cancer, for which efficacy depends on a specific mutation BRAF V600E. One LCMM per indication was implemented to classify treatment responses at the PDX level, analyzing the growth kinetics of treated tumors and matched controls within the PDX models. A simulation study was carried out to explore the performance of LCMM in this context. For both applications, LCMM identified classes for which the higher the proportion of mutated BRAF V600E PDX models the greater the treatment effect, which is aligned with encorafenib use recommendations. The simulation study showed that LCMM could identify classes with large differences in treatment effects. LCMM is a suitable tool for MCT to explore treatment response subgroups of PDX. Once these subgroups are defined, characterization of their phenotypes/genotypes could be performed to explore treatment response predictors.
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Affiliation(s)
- Hélène Savel
- U1219, Inserm Bordeaux Population Health Research Centre, Department of Public Health, Université de Bordeaux, 33000, Bordeaux, France
- Ipsen Innovation, 5 Avenue du Canada, 91940, Les Ulis, France
- Inria, SISTM, 33400, Talence, France
| | | | - Cécile Proust-Lima
- U1219, Inserm Bordeaux Population Health Research Centre, Department of Public Health, Université de Bordeaux, 33000, Bordeaux, France
- Institut Bergonié, CHU de Bordeaux, INSERM, Université de Bordeaux, CIC-EC 1401, 33000, Bordeaux, France
| | - Laura Richert
- U1219, Inserm Bordeaux Population Health Research Centre, Department of Public Health, Université de Bordeaux, 33000, Bordeaux, France.
- Institut Bergonié, CHU de Bordeaux, INSERM, Université de Bordeaux, CIC-EC 1401, 33000, Bordeaux, France.
- Inria, SISTM, 33400, Talence, France.
- Université de Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France.
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