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Adenocarcinoma of the Prostate Phase 2 Binary Endpoint NCT00087139

Ixabepilone in Treating Patients With Metastatic Prostate Cancer: Complete Statistical Analysis

This analysis describes a completed Phase II, single-group study of ixabepilone for metastatic prostate cancer. It focuses on the registry’s PSA-response definition, the limits of the reported outcome information, and how to read the safety figures.

Trial start: 2004-09  ·  Enrollment: 124  ·  Sponsor: National Cancer Institute (NCI)
Scope of this record

This page provides an independent statistical analysis and educational interpretation of publicly reported results. ClinicalTrials.gov provides the official trial registry record. Numerical trial results on this page are restricted to the results posted in the ClinicalTrials.gov record; calculations added by Clinical Biostats are labelled as such.

1. Trial at a Glance

This page covers the registry results for Ixabepilone in Treating Patients With Metastatic Prostate Cancer (NCT00087139), a na phase 2 study. The primary outcome is Proportion of Patients With PSA Response.

124
Enrollment
Phase 2
n/a
Arms
In the primary outcome
n/a
Effect
No re-analysis shown
n/a
95% CI
See limitations
FeatureRegistry value
ClinicalTrials.gov identifierNCT00087139
PhasePhase 2
ConditionAdenocarcinoma of the Prostate, Recurrent Prostate Cancer, Stage IV Prostate Cancer
AllocationNot applicable (single group)
Design modelSingle Group
MaskingNone (open label)
Enrollment124
Arms in the primary outcomen/a
Lead sponsorNational Cancer Institute (NCI)
Results postedYes

2. Clinical Question

Population

Patients with metastatic prostate cancer that had not responded to previous hormone therapy were the study population. The registry also lists adenocarcinoma of the prostate, recurrent prostate cancer, and stage IV prostate cancer as conditions. Patients were stratified by prior chemotherapy: none, 1 prior taxane-containing regimen, or 2 prior cytotoxic regimens.

Intervention

Patients received ixabepilone intravenously over 1 hour on days 1, 8, and 15. Courses were scheduled to repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Comparator

This was a single-group study, with no concurrent comparison group described. The registry lists allocation as not applicable and masking as none, so the study does not provide a randomized, masked comparison with another treatment or control.

Primary question

The primary endpoint was the proportion of patients with a PSA response. A response required a decline from baseline by >=50%, or normalization of PSA to <0.2 ng/lm, confirmed by a second measurement >=4 weeks later. The registry description says the response proportion was calculated separately for 3 strata and only among the first cohort.

The clinical question is therefore whether PSA responses were observed in the defined study population receiving the specified ixabepilone schedule, considered separately by prior-chemotherapy stratum. The registry record does not report the response proportions or their confidence intervals, so the size and precision of any response cannot be assessed from the posted results. The single-group design also means that the study does not estimate a treatment contrast against a concurrent comparator. Its primary outcome is a biomarker response, rather than a direct comparison of survival or another clinical outcome.

3. Trial Design

This completed Phase II study evaluated a weekly schedule of ixabepilone in patients with metastatic prostate cancer that had not responded to previous hormone therapy. The registry records enrollment of 124. It identifies the National Cancer Institute (NCI) as sponsor and gives a study start of 2004-09 and primary completion of 2009-04.

The design is listed as single-group, with allocation not applicable and masking none. Accordingly, the study describes outcomes among patients receiving ixabepilone; it does not contain a concurrent randomized control group. The arm description says patients were stratified according to prior chemotherapy: none, 1 prior taxane-containing regimen, or 2 prior cytotoxic regimens. These strata describe patient history, not separate randomized treatment assignments.

Ixabepilone was administered intravenously over 1 hour on days 1, 8, and 15, with courses repeating every 28 days unless disease progression or unacceptable toxicity occurred. The registry lists 4 outcome measures, including the primary PSA-response outcome and secondary outcomes for measurable disease response, duration of PSA response, and duration of measurable disease response.

The registry description says additional patients could be accrued if the regimen met a protocol-specified PSA response rate, with a target of 25 eligible patients with measurable disease in each stratum. It also says the PSA response rate was calculated only among the first cohort, excluding additional patients accrued to the study. The precise analysis population and the numbers analyzed within each stratum are not reported in the registry record. The protocol’s full statistical plan, including the rationale for its enrollment target, is not reported in the registry record.

4. Participant Flow and Accounting

The registry reports how participants moved through each stage of the study. All counts below are exactly as posted; missing counts are not inferred from other stages.

Overall Study

StageIxabepilone - no Prior ChemoIxabepilone - Prior TaxaneIxabepilone - Two Prior Chemo
STARTED394936
Treated394836
Eligible and Treated354232
Patients for the Analysis of PSA Respons303422
Patients With Measurable Disease222524
Patients With PSA Response1084
Patients w/ Measurable Disease Response520
COMPLETED000
NOT COMPLETED394936

Reasons for not completing this period:

ReasonIxabepilone - no Prior ChemoIxabepilone - Prior TaxaneIxabepilone - Two Prior Chemo
Adverse Event181713
Death210
Withdrawal by Subject322
Physician Decision111
Disease progression91912
Ineligible474
Symptomatic deterioration113
Use of coumadin100
Response achieved010
Extradural disease001

Analysis population for the primary outcome, as defined in the registry: If the regimen demonstrated a PSA response rate specified in the protocol, additional patients would be entered so the total number of eligible patients with measurable disease in each stratum is 25. But the PSA response rate was only calculated among the first cohort of patients, not including the additional patients with measurable disease.

5. Baseline Characteristics

The table reproduces the baseline characteristics posted in the registry, which describe the participants analysed at baseline and help show whether the randomized groups were comparable.

CharacteristicUnitIxabepilone - no Prior ChemoIxabepilone - Prior TaxaneIxabepilone - Two Prior ChemoTotal
Participants analysed354232109
Age, Continuousyears72 (45 to 82)69 (50 to 81)67.5 (49 to 90)70 (45 to 90)
Sex: Female, Male: FemaleParticipants0000
Sex: Female, Male: MaleParticipants354232109

6. Primary Endpoint

The registry lists the primary outcome as Proportion of Patients With PSA Response, measured over Every 4 weeks during treatment; then every 3 months if <2 years from study entry; then every 6 months if 2-5 years from study entry.

ElementRegistry entry
Result typeNumber
Measure of spread90% Confidence Interval
UnitProportion of participants
Endpoint classificationBinary Endpoint

The primary endpoint is the proportion of patients with a PSA response. PSA is a biomarker, and this endpoint classifies whether a participant met a prespecified response definition during treatment. The definition required either a decline from baseline by >=50% or normalization to <0.2 ng/lm, with the qualifying change confirmed by a second measurement >=4 weeks later. Requiring confirmation helps distinguish a sustained qualifying measurement from an isolated result.

The registry specifies PSA assessments every 4 weeks during treatment, then every 3 months if <2 years from study entry, and then every 6 months if 2-5 years from study entry. It reports that the response proportion was evaluated separately for the 3 prior-chemotherapy strata. The description also states that only the first cohort contributed to this calculation, even though additional patients could be accrued under the protocol’s stated condition.

In general, a response proportion offers a straightforward way to describe how often a defined binary outcome occurred in a study group. It does not, by itself, measure how long a response lasts or establish a comparative treatment effect. The registry lists duration of PSA response and measurable disease outcomes separately as secondary outcomes. The primary response estimates and their 90% confidence intervals are not reported in the registry record, so neither the response frequency nor its precision can be evaluated from the available results.

7. Why No Re-analysis Is Shown

Reported as posted, not recalculated. Not a randomized comparison (allocation: NA); arms are not a like-for-like control comparison. A result is recalculated only when the posted data support a clean two-arm comparison, so no result is shown beyond what the sponsor posted.

8. Statistical Interpretation

Clinical Biostats interpretation

The registry identifies a clinically defined PSA-response endpoint and states that the response proportion was calculated separately for 3 prior-chemotherapy strata. However, it does not report the corresponding proportions or the 90% confidence intervals. As a result, the posted results do not establish how often a response occurred in any stratum, how uncertain an estimate might be, or whether the response proportions differed across strata.

The enrollment figure of 124 describes the study, but it should not be treated as the denominator for the primary endpoint. The registry says that the PSA analysis used only the first cohort and excluded additional patients accrued to the study. The numbers contributing to the primary analysis, both overall and within each stratum, are not reported in the registry record. Enrollment, eligibility, receipt of treatment, and inclusion in an endpoint analysis can describe different groups; the record does not provide enough detail to reconcile them for this outcome.

The study’s single-group design is important when interpreting any outcome. A response observed among treated patients would describe what happened in this study group, but without a concurrent comparator it would not quantify how the outcome would have differed under another treatment or no treatment. Stratification by prior chemotherapy provides separate descriptions by treatment history, but it does not create randomized comparison groups. The registry record does not report adjusted or unadjusted comparisons among those strata.

The endpoint definition includes a confirmation requirement, which makes the classification depend on repeat measurement. The schedule for PSA assessment is specified, but the record does not say how missing or delayed measurements were handled, how participants without confirmation were classified, or whether all participants had sufficient follow-up to be assessed. These omissions limit interpretation of the endpoint even if an estimate were available.

The registry lists secondary outcomes for best overall measurable disease response and duration of both PSA and measurable disease response. It does not provide their results in the registry record recorded for this study. No analysis entries are reported, and the primary response estimates themselves are absent. Therefore, conclusions about response frequency, durability, uncertainty, or differences by stratum are not supported by the registry information available. The safety summary is a separate descriptive record and does not fill that efficacy-reporting gap.

9. Statistical Methods Explained

What does a response proportion represent?

In general, a binary endpoint places each participant into a defined outcome category, such as response or no response. A response proportion describes the share of the analyzed group classified as having the event. For this study, the registry defines the event using a PSA decline from baseline by >=50% or normalization to <0.2 ng/lm, with confirmation by a second measurement >=4 weeks later. The definition matters because a different threshold, confirmation rule, or analysis population could produce a different proportion.

The registry calls the endpoint a proportion and specifies a 90% confidence interval as its dispersion measure. In general, a confidence interval conveys uncertainty around an estimated quantity: narrower intervals indicate greater precision, while wider intervals indicate less precision. It is not a guarantee that a particular interval contains the underlying value. No interval limits or response estimates are reported in the registry record, so precision cannot be judged for this endpoint.

Why are the prior-chemotherapy strata relevant?

The study description separates patients according to prior chemotherapy: none, 1 prior taxane-containing regimen, or 2 prior cytotoxic regimens. The PSA response proportion was reported separately for 3 strata according to the primary outcome description. In general, stratified reporting can show whether outcome patterns vary across clinically relevant groups. It does not, on its own, demonstrate that the groups differ: participants in the strata may have different treatment histories, and the study is not described as randomizing patients between those histories or between treatments.

The record does not report the response estimate or denominator for each stratum. It therefore does not permit assessment of the precision of stratum-specific estimates or a formal comparison across strata. The total enrollment figure should not be substituted for stratum-specific analysis denominators.

What does confirmation contribute?

The endpoint requires the qualifying PSA change or normalization to be confirmed by a second measurement at least 4 weeks later. In general, confirmation rules can reduce classification based on a transient or unverified measurement. They also mean that response status depends on having a later measurement available. The registry does not report how participants lacking a confirmatory measurement were handled, or how missing PSA observations were treated.

The record specifies a PSA assessment schedule: every 4 weeks during treatment; then every 3 months if <2 years from study entry; then every 6 months if 2-5 years from study entry. It does not report adherence to that schedule, the timing of individual measurements, or whether outcome assessment was complete for all participants included in the endpoint analysis.

What can be learned from the design?

This is a single-group study with masking listed as none. In general, a single-group endpoint estimate describes outcomes within the treated study group. It does not provide a randomized estimate of the difference between ixabepilone and a concurrent control. Differences between historical groups or between the prior-chemotherapy strata would not be equivalent to a randomized treatment comparison.

The registry reports a 90% confidence interval for the primary endpoint, but the method used to calculate it is not reported in the registry record. The statistical analysis plan, any adjustment procedures, and any interim analyses are also not reported in the registry record. The record describes a protocol condition for accruing additional patients and says the primary PSA response calculation used only the first cohort. It does not give the decision rule’s numerical response threshold or a full account of the accrual and analysis process.

General planning calculations, when used, are not observed power. The planning assumptions recorded for this study describe a two-sided significance level of 0.05, equal allocation between two arms, and a normal approximation, with effects defined as fractions of an observed effect. Those are planning assumptions, not features of this single-group study’s treatment allocation. The record does not report a trial-specific sample-size justification or an observed power analysis.

10. Exact Estimates for Each Arm

No two-arm comparison is shown for this trial, but each arm's result can still be summarized with exact interval estimates computed from the posted counts. The Clopper-Pearson interval is exact and conservative; the Wilson interval is a common closer-to-nominal alternative; the Bayesian credible interval uses a uniform Beta(1, 1) prior. For small groups the three can differ noticeably.

ArmParticipantsEventsObserved %Clopper-Pearson 95% CIWilson 95% CIBayesian 95% credible interval
Ixabepilone - no Prior Chemo3000.0%0.0% to 11.6%0.0% to 11.4%0.1% to 11.2%
Ixabepilone - Prior Taxane3400.0%0.0% to 10.3%0.0% to 10.2%0.1% to 10.0%
Ixabepilone - Two Prior Chemo2200.0%0.0% to 15.4%-0.0% to 14.9%0.1% to 14.8%

R code and output

arm    <- c("Ixabepilone - no Prior Chemo", "Ixabepilone - Prior Taxane", "Ixabepilone - Two Prior Chemo")
n      <- c(30, 34, 22)
events <- c(0, 0, 0)
for (i in seq_along(n)) {
  ci <- binom.test(events[i], n[i])$conf.int          # Clopper-Pearson exact interval
  cr <- qbeta(c(0.025, 0.975), 1 + events[i], 1 + n[i] - events[i])   # Bayesian, uniform Beta(1,1) prior
  wi <- (function(x, n) { p <- x / n; z <- qnorm(0.975); d <- 1 + z^2 / n
    c((p + z^2 / (2 * n) - z * sqrt(p * (1 - p) / n + z^2 / (4 * n^2))) / d, (p + z^2 / (2 * n) + z * sqrt(p * (1 - p) / n + z^2 / (4 * n^2))) / d) })(events[i], n[i])
  cat(sprintf("ARM|%s|%d|%d|%.1f|%.1f|%.1f|%.1f|%.1f|%.1f|%.1f\n", arm[i], n[i], events[i], 100 * events[i] / n[i],
              100 * ci[1], 100 * ci[2], 100 * wi[1], 100 * wi[2], 100 * cr[1], 100 * cr[2]))
}
ARM  Ixabepilone - no Prior Chemo  30  0  0.0  0.0  11.6  0.0  11.4  0.1  11.2
ARM  Ixabepilone - Prior Taxane  34  0  0.0  0.0  10.3  0.0  10.2  0.1  10.0
ARM  Ixabepilone - Two Prior Chemo  22  0  0.0  0.0  15.4  -0.0  14.9  0.1  14.8

11. Multiplicity, Missing Data and Analysis Populations

The registry lists a primary PSA-response outcome and secondary outcomes for measurable disease response, duration of PSA response, and duration of measurable disease response. Having several outcomes raises the general statistical issue of multiplicity: when many hypotheses are examined, the chance of at least one apparently notable result can increase. Whether and how to address that issue depends on the prespecified analysis plan. A multiplicity strategy is not reported in the registry record, so it is not possible to determine whether any adjustment was planned or used.

The record does not report the results for the primary endpoint or the listed secondary outcomes. It also does not report analysis entries, and no statistical analysis plan is available in the registry information. The exact analysis population, stratum-specific denominators, and handling of participants with incomplete endpoint measurements are not reported in the registry record.

Missing-data handling is particularly relevant to a response definition requiring confirmation by a second measurement. In general, participants who lack a confirmatory measurement may be excluded, classified under a prespecified rule, or handled through another approach. Those choices can affect the estimated response proportion. The registry record does not state which approach was used, whether missingness was assessed, or whether sensitivity analyses were conducted.

The description says additional patients could be accrued if a protocol-specified PSA response rate was demonstrated, but the response calculation was restricted to the first cohort and excluded additional accrued patients. The numerical accrual criterion, the relationship between that criterion and the reported analysis, and the analysis-population details are not reported in the registry record. No conclusion about interim monitoring or stopping rules can be drawn from the information recorded.

12. Safety Results

The registry reports serious adverse events as affected participants divided by participants at risk.

ArmParticipants with serious adverse eventsParticipants at riskPercentage
Ixabepilone9012373.2%

Other (non-serious) adverse events

Participants with at least one non-serious event at or above the registry's 5% reporting threshold.

ArmParticipants affected of at risk
Ixabepilone122 of 123

Most frequent serious adverse event terms

Event termOrgan systemIxabepilone
Neuropathy-sensoryNervous system disorders32 of 123
FatigueGeneral disorders28 of 123
LeukopeniaInvestigations27 of 123
NeutropeniaInvestigations22 of 123
Neuropathy-motorNervous system disorders13 of 123
AnorexiaMetabolism and nutrition disorders12 of 123
AnemiaBlood and lymphatic system disorders8 of 123
Diarrhea w/o prior colostomyGastrointestinal disorders7 of 123
NauseaGastrointestinal disorders7 of 123
DehydrationMetabolism and nutrition disorders6 of 123

Most frequent non-serious adverse event terms

Event termOrgan systemIxabepilone
AnemiaBlood and lymphatic system disorders112 of 123
FatigueGeneral disorders89 of 123
LeukopeniaInvestigations84 of 123
Neuropathy-sensoryNervous system disorders66 of 123
AnorexiaMetabolism and nutrition disorders56 of 123
NauseaGastrointestinal disorders56 of 123
NeutropeniaInvestigations51 of 123
AlopeciaSkin and subcutaneous tissue disorders45 of 123
Diarrhea w/o prior colostomyGastrointestinal disorders41 of 123
Taste disturbanceNervous system disorders31 of 123

Serious events with the highest arm-level rate: neuropathy-sensory (26.0%), fatigue (22.8%), leukopenia (22.0%), neutropenia (17.9%), neuropathy-motor (10.6%).

Do not overextend the safety comparison. Serious-adverse-event counts are safety observations, not efficacy outcomes, and should not be combined with the primary result into a single benefit-risk number.

The registry’s safety summary lists 123 participants at risk for serious adverse events, with 90 affected, and 123 at risk for other adverse events, with 122 affected. These are descriptive counts in the ixabepilone group. They are not comparisons with a control group, and they do not establish whether an event was caused by treatment. The registry’s serious-event summary also lists neuropathy-sensory (26.0%), fatigue (22.8%), leukopenia (22.0%), neutropenia (17.9%), neuropathy-motor (10.6%), and anorexia (9.8%).

In general, a serious adverse event is a safety classification and should not be treated as interchangeable with every adverse event or with an event’s severity rating. The registry record does not specify the denominator used for the listed term percentages or provide additional detail about event definitions and timing. The percentages should therefore be read as reported, without inferring a different denominator or calculating new rates. The safety figures describe reported events in this study group; they do not establish comparative safety.

13. What the Result Does, and Does Not, Mean

The registry record establishes that this was a completed Phase II, single-group study of ixabepilone and describes a prespecified PSA-response definition. It also records the schedule of treatment, prior-chemotherapy strata, and a safety summary. Those details clarify what the study set out to measure and the context in which outcomes should be interpreted.

The record does not report the primary PSA-response proportions or their 90% confidence intervals. It therefore does not show the observed response frequency, how precisely it was estimated, or whether responses varied by prior-chemotherapy stratum. Although the registry lists secondary outcomes, their results are not reported in the information available. The absence of these results means the record cannot support a conclusion about the magnitude or duration of response.

Even if response estimates were available, the single-group design would limit what they could establish. An observed response proportion would describe participants in this study; it would not measure a randomized difference against another treatment. The study also stratified by prior chemotherapy rather than assigning those histories at random, so differences between strata could not be interpreted as treatment effects.

The endpoint is a biomarker response defined by a threshold and confirmation rule. In general, a biomarker response is not itself a complete account of patient experience, disease course, or comparative benefit. The registry lists measurable disease and response-duration outcomes separately, but their results are not reported. The available safety counts and listed event percentages are descriptive and likewise do not provide a comparative assessment.

Accordingly, the posted record is informative about design, endpoint definition, and recorded safety events, but it does not provide the efficacy estimates needed to characterize the primary result. It also does not report the analysis details needed to assess missing measurements, denominator selection, or statistical adjustment.

14. Why This Trial Matters Statistically

This study illustrates why a clear endpoint definition is only one part of interpreting a clinical trial. The registry specifies a PSA response threshold, a normalization criterion, and a confirmation measurement. Those details make the intended outcome understandable, but the response proportions and confidence intervals are not reported. Without the estimates and their analysis denominators, neither the frequency nor precision of the endpoint can be evaluated.

The study also highlights the distinction between stratification and randomization. Prior chemotherapy was used to define 3 strata, and the primary outcome description says response proportions were calculated separately for them. This can be useful for describing outcomes across different treatment histories, but it does not remove the limitations of a single-group design or create a controlled treatment comparison.

Its accrual description makes analysis populations especially important. The registry says additional patients could be enrolled under a protocol condition, while the PSA response calculation used only the first cohort. Enrollment and endpoint-analysis populations therefore cannot be assumed to be identical. The reported enrollment figure alone does not reveal how many participants contributed to the primary endpoint or to each stratum.

Finally, the record distinguishes efficacy outcomes from safety summaries. The safety counts and listed event percentages offer descriptive information, while the missing response estimates prevent assessment of the primary efficacy outcome. Together, these features show why registry interpretation requires attention to design, endpoint definitions, denominators, uncertainty, and completeness of outcome reporting—not just the trial’s title or enrollment figure.

15. Limitations

The most important limitation in the registry information is that the primary PSA-response proportions and their 90% confidence intervals are not reported. Although the endpoint is defined and the analysis is described as stratified, the results needed to assess response frequency and precision are absent. The listed secondary outcomes also have no reported results in the record.

The single-group design provides no concurrent treatment comparison. The registry lists allocation as not applicable and masking as none, so the study cannot estimate a randomized contrast. The 3 prior-chemotherapy strata are descriptive categories and do not substitute for randomized groups.

The analysis population is also unclear. The registry reports enrollment of 124, but says the primary PSA calculation used only the first cohort and excluded additional patients accrued to the study. The number analyzed overall, the stratum-specific denominators, and the handling of participants without a confirmed response measurement are not reported in the registry record. The description’s account of the population is incomplete, and the full analysis criteria are not reported.

The registry record does not report the statistical method used for the confidence intervals, a multiplicity adjustment, the missing-data approach, or a complete statistical analysis plan. It does not report the numerical protocol response criterion governing additional accrual. These gaps make it impossible to reconstruct the primary analysis or assess whether all planned outcomes and analysis decisions are fully represented.

The safety summary is descriptive and lacks a concurrent comparator. The denominator for the listed serious-event term percentages and further event-level context are not reported in the registry record. These limitations constrain interpretation of both efficacy and safety information.

16. Related Tutorials

17. Related Statistical Calculators

18. Sources

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19. Record Summary

NCT00087139 is a completed Phase II, single-group study sponsored by the National Cancer Institute (NCI), with enrollment of 124. The registry records a study start of 2004-09 and primary completion of 2009-04. Patients received ixabepilone intravenously on days 1, 8, and 15, with courses scheduled every 28 days in the absence of progression or unacceptable toxicity. Prior chemotherapy defined 3 strata.

The primary endpoint was the proportion of patients with PSA response, defined by a decline from baseline by >=50% or normalization to <0.2 ng/lm, confirmed by a second measurement >=4 weeks later. The registry says the primary response calculation used the first cohort and excluded additional accrued patients. The response estimates, confidence intervals, exact analysis population, and results for the listed secondary outcomes are not reported in the registry record.

The safety summary reports affected counts for serious and other adverse events and lists serious-event terms with percentages. Because the study has no concurrent comparator, these safety figures are descriptive.

Clinical Biostats