Sample size for two-stage studies with maintenance therapy.

An adaptive treatment strategy (ATS) is defined as a sequence of treatments and intermediate responses. ATS' arise when chronic diseases such as cancer and depression are treated over time with various treatment alternatives depending on intermediate responses to earlier treatments. Clinical trials are often designed to compare ATSs based on appropriate designs such as sequential randomization designs. Although recent literature provides statistical methods for analyzing data from such trials, very few articles have focused on statistical power and sample size issues. This paper presents a sample size formula for comparing the survival probabilities under two treatment strategies sharing same initial, but different maintenance treatment. The formula is based on the large sample properties of inverse-probability-weighted estimator. Simulation study shows strong evidence that the proposed sample size formula guarantees desired power, regardless of the true distributions of survival times. Copyright 2009 John Wiley & Sons, Ltd.