Combining estimates from multiple early studies to obtain estimates of response: using shrinkage estimates to obtain estimates of response.

Development of anti-cancer therapies usually involve small to moderate size studies to provide initial estimates of response rates before initiating larger studies to better quantify response. These early trials often each contain a single tumor type, possibly using other stratification factors. Response rate for a given tumor type is routinely reported as the percentage of patients meeting a clinical criteria (e.g. tumor shrinkage), without any regard to response in the other studies. These estimates (called maximum likelihood estimates or MLEs) on average approximate the true value, but have variances that are usually large, especially for small to moderate size studies. The approach presented here is offered as a way to improve overall estimation of response rates when several small trials are considered by reducing the total uncertainty.The shrinkage estimators considered here (James-Stein/empirical Bayes and hierarchical Bayes) are alternatives that use information from all studies to provide potentially better estimates for each study. While these estimates introduce a small bias, they have a considerably smaller variance, and thus tend to be better in terms of total mean squared error. These procedures provide a better view of drug performance in that group of tumor types as a whole, as opposed to estimating each response rate individually without consideration of the others. In technical terms, the vector of estimated response rates is nearer the vector of true values, on average, than the vector of the usual unbiased MLEs applied to such trials. Copyright (c) 2006 John Wiley & Sons, Ltd.