e23028 Background: As Kaplan-Meier (KM) analyzes single unidirectional endpoints, most advanced cancer randomized clinical trials (RCTs) are powered for a 10 endpoint of either progression free survival (PFS) or overall survival (OS). This disregards efficacy information carried by stable disease (SD), partial response (PR), and complete response (CR) that may precede progressive disease (PD) and death. Chauhan Weighted Trajectory Analysis (CWTA), a generalization of KM, permits simultaneous evaluation of multiple rank ordered endpoints. We hypothesized that using CWTA with all efficacy inputs could expedite RCT efficacy signals. Methods: We performed 100-fold simulations of RCTs in advanced cancer and determined the time to first significant efficacy signal (p < 0.05) for KM PFS and OS (logrank test) and CWTA (weighted logrank test). RCTs were stochastically generated at defined sample size (SS) allocated 1:1 to control or intervention and run for 60 months. Rank ordered health statuses were CR = 0, PR = 1, SD = 2, PD = 3, and Death = 4. All patients we assigned SD at time 0 and, each month, were capable of response (PR then CR), maintained SD, or irreversible exacerbation to PD or Death. Event probabilities were modified between groups as defined by a hazard ratio (HR). We modeled a control group CR rate of ~10% and a PR rate of ~50% to reflect first-line advanced cancer RCTs with a dropout rate of 10% over 60 months. At increments of SS and HR, we determined the mean and standard deviation of time-to-efficacy signals. Results: CWTA markedly reduced the time-to-efficacy signals when compared to KM PFS (23% to 67%) and KM OS (43% to 82%) (Table 1). Conclusions: CWTA, by incorporating the entirety of the cancer trajectory including disease response, progression, and death, meaningfully expedites the efficacy signals of cancer treatments compared to KM PFS and OS. We have previously reported CWTA increases trial power and reduces sample size requirements (Chauhan U, Zhao K, Walker J, Mackey JR; 2023. DOI: 10.3390/biomedinformatics3040052). Using CWTA rather than KM reduces trial duration, cost, and numbers of patients needed to evaluate therapies in advanced cancer, while reducing the regulatory risk inherent in powering a trial for a single KM primary endpoint. [Table: see text]
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