A confirmatory basket design considering non-inferiority and superiority testing

ABSTRACT

For multiple rare diseases as defined by a common biomarker signature, or a disease with multiple disease subtypes of low frequency, it is often possible to provide confirmatory evidence for these disease or subtypes (baskets) as a combined group. A novel drug, as a second generation, may have marginal improvement in efficacy overall but superior efficacy in some baskets. In this situation, it is appealing to test hypotheses of both non-inferiority overall and superiority on certain baskets. The challenge is designing a confirmatory study efficient to address multiple questions in one trial. A two-stage adaptive design is proposed to test the non-inferiority hypothesis at the interim stage, followed by pruning and pooling before testing a superiority hypothesis at the final stage. Such a design enables an efficient and novel registration pathway, including an early claim of non-inferiority followed by a potential label extension with superiority on certain baskets and an improved benefit-risk profile demonstrated by longer term efficacy and safety data. Operating characteristics of this design are examined by simulation studies, and its appealing features make it ready for use in a confirmatory setting, especially in emerging markets, where both the need and the possibility for efficient use of resources may be the greatest.

KEYWORDS:

• Basket design
• non-inferiority
• two-stage design

Disclosure statement

Robert A. Beckman has received consulting fees from AstraZeneca and Boehringer Ingelheim in the past 12 months. He is also the Chief Scientific Officer (uncompensated) for Onco-Mind, LLC, which owns patents related to precision therapy of cancer.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.