Double robust estimation of optimal partially adaptive treatment strategies: An application to breast cancer treatment using hormonal therapy

Stat Med. 2023 Jan 30;42(2):178-192. doi: 10.1002/sim.9608. Epub 2022 Nov 21.

Abstract

Precision medicine aims to tailor treatment decisions according to patients' characteristics. G-estimation and dynamic weighted ordinary least squares are double robust methods to identify optimal adaptive treatment strategies. It is underappreciated that they require modeling all existing treatment-confounder interactions to be consistent. Identifying optimal partially adaptive treatment strategies that tailor treatments according to only a few covariates, ignoring some interactions, may be preferable in practice. Building on G-estimation and dWOLS, we propose estimators of such partially adaptive strategies and demonstrate their double robustness. We investigate these estimators in a simulation study. Using data maintained by the Centre des Maladies du Sein, we estimate a partially adaptive treatment strategy for tailoring hormonal therapy use in breast cancer patients. R software implementing our estimators is provided.

Keywords: causal inference; double robustness; dynamic treatment regimens; inverse probability weighting; personalized medicine; precision medicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Neoplasms* / drug therapy
  • Computer Simulation
  • Female
  • Humans
  • Models, Statistical*
  • Precision Medicine / methods
  • Software