Early Phase Dose-Finding Designs for CAR-T Cell Therapies.

Chimeric Antigen Receptor (CAR)-T cell is an immunotherapy which revolutionised the treatment of relapsed/refractory lymphoma and leukaemia. It is shown to have a higher response rate, higher mid-to-long term overall survival, and lower toxicity than standard treatments. However, due to a lack of dose-limiting toxicity (DLT) and unclear dose-effect relationship, traditional phase I designs of clinical trials cannot lead to accurate selections of the optimal dose (OD). Beside clinical outcomes, the CAR-T cell expansion from serial blood samples is measured at various time points. We propose a novel early phase dose-finding design for CAR-T cells, using both toxicity and activity endpoints to locate the OD. The number of CAR-T cells measured in the peripheral blood is used to indicate activity, which is more sensitive than the short-term clinical responses traditionally used. A Bi-Exponential model is used for the repeated measures of the number of cells for each patient, and is estimated under a Bayesian framework. The model is motivated by biological concerns and is flexible enough to accommodate different shapes of the cell-expansion curve. Three criteria for activity are considered: (1) the number of cells at specific time points, (2) the duration before all cells are eliminated, (3) the area under the cell-expansion curve. Simulation studies show that the OD can be selected with high accuracy even under small sample sizes.