Minimax and admissible adaptive two-stage designs in phase II clinical trials

BACKGROUND: Simon’s two-stage design is the most widely implemented among multi-stage designs in phase II clinical trials to assess the activity of a new treatment in a single-arm study. In this two-stage design, the sample size from the second stage is fixed regardless of the number of responses observed in the first stage. METHODS: We develop a new minimax adaptive design for phase II clinical trials, by using the branch-and-bound intelligent algorithm based on conditional error functions. RESULTS: We compare the performance of the proposed design and competitors, including Simon’s minimax design, and a modified Simon’s design that allows early stopping for futility or efficacy. The maximum sample size of the proposed minimax adaptive design is guaranteed to be less than or equal to those from other existing designs. When the proposed design has the same maximum sample size as others, it always has the smallest expected sample size. In addition to the minimax adaptive design, we also introduce admissible adaptive designs determined from a Bayesian perspective. CONCLUSIONS: The proposed adaptive minimax design can save sample sizes for a clinical trial. The minimum required sample size is critical to reduce the cost of a project.