Author ORCID Identifier


Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Roy T. Sabo

Second Advisor

David C. Wheeler

Third Advisor

Le Kang

Fourth Advisor

Amir Toor

Fifth Advisor

Qiong Zhang


Response-Adaptive (RA) designs are used to adaptively allocate patients in clinical trials. These methods have been generalized to include Covariate-Adjusted Response-Adaptive (CARA) designs, which adjust treatment assignments for a set of covariates while maintaining features of the RA designs. Challenges may arise in multi-center trials if differential treatment responses and/or effects among sites exist. We propose Site-Adjusted Response-Adaptive (SARA) approaches to account for inter-center variability in treatment response and/or effectiveness, including either a fixed site effect or both random site and treatment-by-site interaction effects to calculate conditional probabilities. These success probabilities are used to update assignment probabilities for allocating patients between treatment groups as subjects accrue. Both frequentist and Bayesian models are considered. Treatment differences could also be attributed to differences in social determinants of health (SDH) that often manifest, especially if unmeasured, as spatial heterogeneity amongst the patient population. In these cases, patient residential location can be used as a proxy for these difficult to measure SDH. We propose the Location-Adjusted Response-Adaptive (LARA) approach to account for location-based variability in both treatment response and/or effectiveness. A Bayesian low-rank kriging model will interpolate spatially-varying joint treatment random effects to calculate the conditional probabilities of success, utilizing patient outcomes, treatment assignments and residential information. We compare the proposed methods with several existing allocation strategies that ignore site for a variety of scenarios where treatment success probabilities vary.


© Brian S. Di Pace

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