Statistical analysis plan for the Dual mTorc Inhibition in advanCed/recurrent Epithelial ovarian, fallopian tube or primary peritoneal cancer (of clear cell, endometrioid and high-grade serous type, and carcinosarcoma) trial (DICE)

Consuelo Nóhpal de la Rosa, Jonathan Krell, Emily Day, Aaron Clarke, Meena Reddi, Lee Webber, Francesca Fiorentino, Consuelo Nóhpal de la Rosa, Jonathan Krell, Emily Day, Aaron Clarke, Meena Reddi, Lee Webber, Francesca Fiorentino

Abstract

Background: Treatment for ovarian cancer includes platinum-based chemotherapy, but many women become resistant to chemotherapy, becoming platinum-resistant. Standard of care for these women is weekly paclitaxel chemotherapy, but cancers can often become paclitaxel resistant. TAK228, an investigational dual TORC1/2 inhibitor, is an oral therapy that can be added to standard treatment. The DICE trial is a phase II international multicentre, parallel-group, superiority clinical trial with 1:1, open label randomisation which has the aim of investigating the effectiveness of TAK228 plus weekly paclitaxel. The planned sample size is 124 women (62 per treatment arm) with platinum-resistant ovarian cancer.

Objective: To outline the planned analyses for DICE in a statistical analysis plan (SAP) before database hard lock and the start of analysis. This ensures that bias is minimised during the analysis phase.

Results: This SAP provides detailed descriptions of the analysis principles and statistical procedures for analysing primary and secondary outcomes of the trial. The primary outcome is overall progression-free survival (PFS). Secondary outcomes include progression-free survival (PFS) at 24 weeks, overall response rate (ORR), duration of response (DoR), time to progression (TTP), clinical benefit rate (CBR) at 4 months, Cancer Antigen 125 (CA125) response according to Gynaecological Cancer Intergroup (GCIG) criteria, overall survival (OS), safety and tolerability as assessed by adverse events and the quality-of-life questionnaires (EORTC QLQ-C30 and EORTC QLQ-OV28). This detailed description includes significance levels, sensitivity analyses and compliance analysis.

Discussion: The DICE trial will determine whether the addition of TAK228 to weekly paclitaxel chemotherapy shows a statistically significant improvement to participant's progression free and overall survival and that the adverse events (AEs) and quality of life (QoL) are not significantly worse than the standard treatment. The study commenced recruitment in September 2018. An interim analysis was performed in early 2021, the results of which advised continuation of the trial. The study recruitment is ongoing and is due to complete by the end of 2021.

Trial registration: ClinicalTrials.gov NCT03648489 . Registered on 27 August 2018.

Keywords: Ovarian cancer; Paclitaxel; Platinum-resistant; Randomised controlled trial; Statistical analysis plan; TAK228.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

References

    1. Dual mTorc Inhibition in advanCed/Recurrent Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer (of Clear Cell, Endometrioid and High Grade Serous Type, and Carcinosarcoma) (DICE). [ONLINE]. .
    1. ICH harmonised tripartite guideline. Statistical principles for clinical trials. European Medicines Agency. [Online] 1998. .
    1. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eisenhauer, E. A., et al. 2009, European Journal of Cancer, Vol. 45, pp. 228-247.
    1. EORTC Quality of Life. [Online] .
    1. Committee for Medicinal Products for Human Use. ICH E9 (R1) addendum on estimands and sensitivity analysis in clinical trials to the guideline on statistical principles for clinical trials. s.l. : European Medicines Agency, 2020.
    1. Jennison, Christopher and Turnbull, Bruce W. Group sequential methods with applications to clinical trials. s.l. : Chapman and Hall/CRC, 2000. 9780849303166.
    1. Assessment of futility in clinical trials. Snapinn, Steven, et al. 4, Oct-Dec 2006, Pharmaceutical Statistics, Vol. 5, pp. 273-81.
    1. A Multiple Testing Procedure for Clinical Trials. Fleming, Peter C. O'Brien and Thomas R. pp. 549-556, Sep 1979, Biometrics, Vol. 35, 35, 3, DOI: 10.2307/2530245.
    1. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Schulz, Kenneth F, Altman, Douglas G and Moher, David. 340, 2010, BMJ, p. c332, DOI: 10.1136/bmj.c332.
    1. Impact of nonadherence to cancer therapy. Hansen, Lea Ann. 2012, JHOP.
    1. Statistical issues and recommendation for clinical trials conducted during the COVID-19 pandemic. Meyer, R. Daniel, et al. 2020, Statistics in Biopharmaceutical Research, pp. 1-13.
    1. Yang S. The effects of overstratification on the stratified log. USA: University of Pittsburgh; 2012.
    1. Rabe-Hesketh, Sophia and Skrondal, Anders. Multilevel and longitudinal modeling using Stata. s.l. : Stata Press, 2005.
    1. U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES. Common Terminology Criteria for Adverse Events (CTCAE) v4.03. [Online] 14 June 2010. .
    1. A four-step strategy for handling missing outcome data in randomised trials affected by a pandemic. Cro, Suzie, et al. 2020, BMC Medical Research Methodology, Vol. 20, pp. 1-12.
    1. When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guid with flowcharts. Jakobsen, Janus Christian, et al. 162, 2017, BMC Medical Research Methodology, Vol. 17, 1, DOI: 10.1186/s12874-017-0442-1.
    1. Sensitivity analysis in multiple imputation in effectiveness studies of psychotherapy. Crameri, Aureliano, et al. 1042, 27 July 2015, Frontiers in Psychology, Vol. 6, 6. 10.3389/fpsyg.2015.01042.

Source: PubMed

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