Optimal Biological Dose Combination Finding: A Design Roadmap and Robust Cross-Indication Bayesian Borrowing

Abstract

Early-phase combination oncology trials increasingly seek the optimal biological dose combination (OBDC) rather than a maximum tolerated dose combination, in line with the FDA's Project Optimus initiative. Existing Bayesian OBDC designs span rule-based, model-assisted, and model-based paradigms, but no unified framework exists for choosing among them, and none supports borrowing information across indications sharing a combination regimen. We propose a corrected three-by-two taxonomy of OBDC designs by mechanism and objective, a rule-based design (Ji3+3-Comb) closing a documented gap in transparent, model-free combination dose-finding, and a Bayesian Hierarchical Utility-based Cross-indication (BHUC) design that borrows information across indications via a robust mixture prior while discounting non-exchangeable information. We derive the shared utility function as the Bayes-optimal decision under a linear clinical loss, and prove that BHUC's mixture-prior posterior weight automatically vanishes as two indications'true rates become discordant, formalizing its robustness to non-exchangeable borrowing, and complement this asymptotic guarantee with an exact, sample-size-free ceiling on borrowed influence that holds even before any own-indication data accrue. A roadmap links trial features to design choice, and a 5000-replication simulation study, sensitivity analyses, and a case study built from a published phase Ib trial show that model-assisted designs offer the most robust safety-efficacy trade-off, while BHUC improves correct selection over independent per-indication designs even under discordance. We conclude with concrete, protocol-actionable recommendations for pharmaceutical and trial biostatisticians, and directions for future methodological and computational development.