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The experimental design has three components in this context: determination of spontaneous response, sample size calculation, and dose allocation.
Escalation with over-dose control (the EWOC) is a Bayesian adaptive Phase I clinical trial design that can accurately estimate the maximum tolerated dose (MTD) level and control the probability of overdosing patients during the dose allocation phase.
This assay will be carried out in a blinded fashion without the operators knowing the dose allocation for participants.
We did not blind the dose allocation, but the placebo group was additionally 1 1 randomized to low- or high-dose placebo to maintain blinding of the drug.
The continual reassessment method (CRM) (O'Quigley et al, 1990; Garrett-Mayer, 2006; O'Quigley and Zohar, 2006) was used as the dose allocation rule in the trial.
As an example, we can use prognostic information such as the degree of prior treatment to obtain a more accurate dose allocation for each patient (Geoerger et al, 2005).
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A second limitation is that the dose allocations were not randomly performed.
There are inaccuracies in retrospective dose allocations in such studies because radiotherapy causes breast shrinkage, leading to changes in breast shape of treated women over time.
However the investigators and outcome assessors were not blinded to the dose group allocation.
Only the study pharmacists had access to the randomization codes that revealed the dose group allocation.
Compared with a standard dosing trial an adaptive design has the advantage of not having to make definitive decisions prior to trial regarding dose and allocation to predesignated treatment groups.
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