Monthly Archives: November 2016

The changing skyline

Back in the early 2000s, I worked a couple of years as a senior scientist at the Institute for Systems Biology in Seattle. So it was nice to revisit the area for the recent Seventh American Conference on Pharmacometrics (ACoP7).

A lot has changed in Seattle in the last 15 years. The area around South Lake Union, near where I lived, has been turned into a major hub for biotechnology and the life sciences. Amazon is constructing a new campus featuring giant ‘biospheres’ which look like nothing I have ever seen.

Attending the conference, though, was like a blast from the past – because unlike the models used by architects to design their space-age buildings, the models used in pharmacology have barely moved on.

While there were many interesting and informative presentations and posters, most of these involved relatively simple models based on ordinary differential equations, very similar to the ones we were developing at the ISB years ago. The emphasis at the conference was on using models to graphically present relationships, such as the interaction between drugs when used in combination, and compute optimal doses. There was very little about more modern techniques such as machine learning or data analysis.

There was also little interest in producing models that are truly predictive. Many models were said to be predictive, but this just meant that they could reproduce some kind of known behaviour once the parameters were tweaked. A session on model complexity did not discuss the fact, for example, that complex models are often less predictive than simple models (a recurrent theme in this blog, see for example Complexity v Simplicity, the winner is?). Problems such as overfitting were also not discussed. The focus seemed to be on models that are descriptive of a system, rather than on forecasting techniques.

The reason for this appears to come down to institutional effects. For example, models that look familiar are more acceptable. Also, not everyone has the skills or incentives to question claims of predictability or accuracy, and there is a general acceptance that complex models are the way forward. This was shown by a presentation from an FDA regulator, which concentrated on models being seen as gold-standard rather than accurate (see our post on model misuse in cardiac models).

Pharmacometrics is clearly a very conservative area. However this conservatism means only that change is delayed, not that it won’t happen; and when it does happen it will probably be quick. The area of personalized medicine, for example, will only work if models can actually make reliable predictions.

As with Seattle, the skyline may change dramatically in a very short time.

Time-dependent bias of tumour growth rate and time to tumour re-growth

The title of this blog entry refers to a letter published in the journal entitled, CPT: Pharmacometrics & Systems Pharmacology. The letter is open-access so those of you interested can read it online here.  In this blog entry we will go through it.

The letter discusses a rather strange modelling practice which is becoming the norm within certain modelling and simulation groups in the pharmaceutical industry. There has been a spate of publications citing that tumour re-growth rate (GR) and time to tumour re-growth (TTG), derived using models to describe imaging time-series data, correlates to survival [1-6]. In those publications the authors show survival curves (Kaplan-Meiers) highlighting a very strong relationship between GR/ TTG and survival.  They either split on the median value of GR/TTG or into quartiles and show very impressive differences in survival times between the groups created; see Figure 2 in [4] for an example (open access).

Do these relationships seem too good to be true? In fact they may well be. In order to derive GR/TTG you need time-series data. The value of these covariates are not known at the beginning of the study, and only become available after a certain amount of time has passed.  Therefore this type of covariate is typically referred to as a time-dependent covariate. None of the authors in [1-6] describe GR/TTG as a time-dependent covariate nor treat it as such.

When the correlations to survival were performed in those articles the authors assumed that they knew GR/TTG before any time-series data was collected, which is clearly not true. Therefore survival curves, such as Figure 2 in [4], are biased as they are based on survival times calculated from study start time to time of death, rather than time from when GR/TTG becomes available to time of death.  Therefore, the results in [1-6] should be questioned and GR/TTG should not be used for decision making, as the question around whether tumour growth rate correlates to survival is still rather open.

Could it be the case that the GR/TTG correlation to survival is just an illusion of a flawed modelling practice?  This is what we shall answer in a future blog-post.

[1] W.D. Stein et al., Other Paradigms: Growth Rate Constants and Tumor Burden Determined Using Computed Tomography Data Correlate Strongly With the Overall Survival of Patients With Renal Cell Carcinoma, Cancer J (2009)

[2] W.D. Stein, J.L. Gulley, J. Schlom, R.A. Madan, W. Dahut, W.D. Figg, Y. Ning, P.M. Arlen, D. Price, S.E. Bates, T. Fojo, Tumor Regression and Growth Rates Determined in Five Intramural NCI Prostate Cancer Trials: The Growth Rate Constant as an Indicator of Therapeutic Efficacy, Clin. Cancer Res. (2011)

[3] W.D. Stein et al., Tumor Growth Rates Derived from Data for Patients in a Clinical Trial Correlate Strongly with Patient Survival: A Novel Strategy for Evaluation of Clinical Trial Data, The Oncologist.  (2008)

[4] K. Han, L. Claret, Y. Piao, P. Hegde, A. Joshi, J. Powell, J. Jin, R. Bruno, Simulations to Predict Clinical Trial Outcome of Bevacizumab Plus Chemotherapy vs. Chemotherapy Alone in Patients With First-Line Gastric Cancer and Elevated Plasma VEGF-A, CPT Pharmacomet. Syst. Pharmacol. (2016)

[5] J. van Hasselt et al., Disease Progression/Clinical Outcome Model for Castration-Resistant Prostate Cancer in Patients Treated With Eribulin, CPT Pharmacomet. Syst. Pharmacol. (2015)

[6] L. Claret et al., Evaluation of Tumor-Size Response Metrics to Predict Overall Survival in Western and Chinese Patients With First-Line Metastatic Colorectal Cancer, J. Clin. Oncol. (2013)