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Early phase, personalized dose-finding trials for combination therapies seek to identify patient-specific optimal biological dose (OBD) combinations, which are defined as safe dose combinations which maximize therapeutic benefit for a specific covariate pattern. Given the small sample sizes which are typical of these trials, it is challenging for traditional parametric approaches to identify OBD combinations across multiple dosing agents and covariate patterns. To address these challenges, we propose a Bayesian optimization approach to dose-finding which formally incorporates toxicity information into both the initial data collection process and the sequential search strategy. Independent Gaussian processes are used to model the efficacy and toxicity surfaces, and an acquisition function is utilized to define the dose-finding strategy and an early stopping rule. This work is motivated by a personalized dose-finding trial which considers a dual-agent therapy for obstructive sleep apnea, where OBD combinations are tailored to obstructive sleep apnea severity. To compare the performance of the personalized approach to a standard approach where covariate information is ignored, a simulation study is performed. We conclude that personalized dose-finding is essential in the presence of heterogeneity.
Willard et al. (Wed,) studied this question.