Design of experiment in drug development: optimal allocations in multi-arm clinical trials and design space for multi-step processes

In this thesis, we deal with the design of experiments in the drug development process, focusing on the design of clinical trials for treatment comparisons (Part I) and the design of preclinical laboratory experiments for proteins development and manufacturing (Part II). In Part I we propose a multi-purpose design methodology for sequential clinical trials. We derived optimal allocations of patients to treatments for testing the efficacy of several experimental groups by also taking into account ethical considerations. We first consider exponential responses for survival trials and we then present a unified framework for heteroscedastic experimental groups that encompasses the general ANOVA set-up. The very good performance of the suggested optimal allocations, in terms of both inferential and ethical characteristics, are illustrated analytically and through several numerical examples, also performing comparisons with other designs proposed in the literature. Part II concerns the planning of experiments for processes composed of multiple steps in the context of preclinical drug development and manufacturing. Following the Quality by Design paradigm, the objective of the multi-step design strategy is the definition of the manufacturing design space of the whole process and, as we consider the interactions among the subsequent steps, our proposal ensures the quality and the safety of the final product, by enabling more flexibility and process robustness in the manufacturing.

Neural states in parietal areas during arm reaching

Since the first subdivisions of the brain into macro regions, it has always been thought a priori that, given the heterogeneity of neurons, different areas host specific functions and process unique information in order to generate a behaviour. Moreover, the various sensory inputs coming from different sources (eye, skin, proprioception) flow from one macro area to another, being constantly computed and updated. Therefore, especially for non-contiguous cortical areas, it is not expected to find the same information. From this point of view, it would be inconceivable that the motor and the parietal cortices, diversified by the information encoded and by the anatomical position in the brain, could show very similar neural dynamics. With the present thesis, by analyzing the population activity of parietal areas V6A and PEc with machine learning methods, we argue that a simplified view of the brain organization do not reflect the actual neural processes. We reliably detected a number of neural states that were tightly linked to distinct periods of the task sequence, i.e. the planning and execution of movement and the holding of target as already observed in motor cortices. The states before and after the movement could be further segmented into two states related to different stages of movement planning and arm posture processing. Rather unexpectedly, we found that activity during the movement could be parsed into two states of equal duration temporally linked to the acceleration and deceleration phases of the arm. Our findings suggest that, at least during arm reaching in 3D space, the posterior parietal cortex (PPC) shows low-level population neural dynamics remarkably similar to those found in the motor cortices. In addition, the present findings suggest that computational processes in PPC could be better understood if studied using a dynamical system approach rather than studying a mosaic of single units.

A phase II, single arm study of CarbopLatin plus Etoposide with Bevacizumab and Atezolizumab in patients with exTEnded-disease small-cell lung cancer (SCLC) – CeLEBrATE trial

Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumor diagnosed at extended disease SCLC (ES-SCLC) stage in about 70% of cases. The new standard of treatment for patients with ES-SCLC is a combination of platinum-etoposide chemotherapy and atezolizumab or durvalumab, two programmed cell death ligand 1 (PD-L1) inhibitory monoclonal antibodies (mAb). However, the benefit derived from the addition of PD-L1 inhibitors to chemotherapy in ES-SCLC was limited and restricted to a subset of patients. The vascular endothelial growth factor (VEGF) is the most important pro-angiogenic factor implicated in cancer angiogenesis, which is abundant in SCLC and associated with poor prognosis. Antiangiogenic agents, such as bevacizumab, a humanized mAb against VEGF, added to platinum-etoposide chemotherapy improved progression-free survival in SCLC in two trials, but it did not translate into a benefit in overall survival. Nevertheless, VEGF has also acts as a mediator of an immunosuppressive microenvironment and its inhibition can revert the immune-suppressive tumor microenvironment and potentially enhance the efficacy of immunotherapies. Based on available preclinical data, we hypothesized that VEGF inhibition by bevacizumab could improve atezolizumab efficacy in a synergistic way and designed a phase II single-arm trial of bevacizumab in combination with carboplatin, etoposide, and atezolizumab as first-line treatment in ES-SCLC. The trial, which is still ongoing, enrolled 53 patients, including those with treated or untreated asymptomatic brain metastases (provided criteria are met), who received atezolizumab, bevacizumab, carboplatin and etoposide for 4-6 cycles (induction phase), followed by maintenance with atezolizumab and bevacizumab for a maximum of 18 total cycles or until disease progression, patient refusal, unacceptable toxicity. The evaluation of efficacy of the experimental combination in terms of 1-year overall survival rate is not yet mature (primary objective of the trial). The combination was feasible and the toxicity profile manageable (secondary objective of the trial).

Relative influence of gaze and static arm position in the Superior Parietal Lobule of the macaque monkey during reaching

The superior parietal lobule (SPL) of macaques is classically described as an associative cortex implicated in visuospatial perception, planning and control of reaching and grasping movements (De Vitis et al., 2019; Galletti et al., 2003, 2018, 2022; Fattori et al., 2017; Hadjidimitrakis et al., 2015). These processes are the result of the integration of signals related to different sensory modalities. During a goal-directed action, eye and limb information are combined to ensure that the hand is transported at the gazed target location and the arm is maintained steady in the final position. The SPL areas V6A, PEc and PE contain cells sensitive to the direction of gaze and limb position but less is known about the degree of independent encoding of these signals. In this thesis, we evaluated the influence of eye and arm position information upon single neuron activity of areas V6A, PEc and PE during the holding period after the execution of arm reaching movement, when the gaze and hand are both still at the reach target. Two male macaques (Macaca fascicularis) performed a reaching task while single unit activity was recorded from areas V6A, PEc and PE. We found that neurons in all these areas were modulated by eye and static arm positions with a joint encoding of gaze and somatosensory signals in V6A and PEc and a mostly separate processing of the two signals in PE. The elaboration of this information reflects the functional gradient found in the SPL with the caudal sector characterized by visuo-somatic properties in comparison to the rostral sector dominated by somatosensory signals. This evidence well agree also with the recent reallocation of areas V6A and PEc in Brodmann’s area 7 depending on their similar structural and functional features with respect to PE belonging to Brodmann’s area 5 (Gamberini et al., 2020).

Trajectory planning of single and dual-arm robots for time-optimal handling of liquids and objects

This Thesis studies the optimal control problem of single-arm and dual-arm serial robots to achieve the time-optimal handling of liquids and objects. The first topic deals with the planning of time-optimal anti-sloshing trajectories of an industrial robot carrying a cylindrical container filled with a liquid, considering 1-dimensional and 2-dimensional planar motions. A technique for the estimation of the sloshing height is presented, together with its extension to 3-dimensional motions. An experimental validation campaign is provided and discussed to assess the thoroughness of such a technique. As far as anti-sloshing trajectories are concerned, 2-dimensional paths are considered and, for each one of them, three constrained optimizations with different values of the sloshing-height thresholds are solved. Experimental results are presented to compare optimized and non-optimized motions. The second part focuses on the time-optimal trajectory planning for dual-arm object handling, employing two collaborative robots (cobots) and adopting an admittance-control strategy. The chosen manipulation approach, known as cooperative grasping, is based on unilateral contact between the cobots and the object, and it may lead to slipping during motion if an internal prestress along the contact-normal direction is not prescribed. Thus, a virtual penetration is considered, aimed at generating the necessary internal prestress. The stability of cooperative grasping is ensured as long as the exerted forces on the object remain inside the static-friction cone. Constrained-optimization problems are solved for 3-dimensional paths: the virtual penetration is chosen among the control inputs of the problem and friction-cone conditions are treated as inequality constraints. Also in this case experiments are presented in order to prove evidence of the firm handling of the object, even for fast motions.