knitr::opts_chunk$set( collapse = TRUE, comment = "#>" ) library(admiraldev)
This article describes creating an ADRS
ADaM with common oncology endpoint
parameters based on RECIST v1.1. Therefore response values are expected as
either CR
, PR
, SD
, NON-CR/NON-PD
, PD
or NE
.
For confirmation of response particularly, CR
, the case that CR
is followed
by PR
(or SD
) is considered as a data issue and the derivations of the
parameters don't handle this case specially. The {admiralonco}
functions don't
provide functionality to handle this case. It is recommended to fix the issue in
the source data, e.g., by changing the PR
to PD
rather than handling it in
the parameter derivations. This ensures consistency across parameters. The
functions derive_param_confirmed_bor()
and derive_param_confirmed_resp()
issue a warning if CR
is followed by PR
(the warning does not display if
CR
is followed by SD
).
Please note that this vignette describes the endpoints which were considered by the admiralonco team as the most common ones. The admiralonco functions used to derive these endpoints provide a certain flexibility, e.g., specifying the reference date or time windows for confirmation or stable disease. If different endpoints or more flexibility is required please read Creating ADRS (Including Non-standard Endpoints).
Examples are currently presented and tested using ADSL
(ADaM) and
RS
, TU
(SDTM) inputs. However, other domains could be used. The
functions and workflow could similarly be used to create an intermediary
ADEVENT
ADaM.
Note: All examples assume CDISC SDTM and/or ADaM format as input unless otherwise specified.
AVAL
for New ParametersASEQ
To start, all data frames needed for the creation of ADRS
should be
read into the environment. This will be a company specific process. Some
of the data frames needed may be ADSL
, RS
and TU
.
For example purpose, the SDTM and ADaM datasets (based on CDISC Pilot test
data)---which are included in {pharmaversesdtm}
and {pharmaverseadam}
---are
used.
library(admiral) library(admiralonco) library(dplyr) library(pharmaversesdtm) library(pharmaverseadam) library(lubridate) library(stringr) data("adsl") data("rs_onco_recist") data("tu_onco_recist") rs <- rs_onco_recist tu <- tu_onco_recist rs <- convert_blanks_to_na(rs) tu <- convert_blanks_to_na(tu)
# select subjects from adsl such that there is one subject without RS data rs_subjects <- unique(rs$USUBJID) adsl_subjects <- unique(adsl$USUBJID) adsl <- filter( adsl, USUBJID %in% union(rs_subjects, setdiff(adsl_subjects, rs_subjects)[1]) )
At this step, it may be useful to join ADSL
to your RS
domain. Only
the ADSL
variables used for derivations are selected at this step. The
rest of the relevant ADSL
would be added later.
adsl_vars <- exprs(RANDDT) adrs <- derive_vars_merged( rs, dataset_add = adsl, new_vars = adsl_vars, by_vars = get_admiral_option("subject_keys") )
dataset_vignette( adrs, display_vars = exprs(USUBJID, RSTESTCD, RSDTC, VISIT, RANDDT), filter = RSTESTCD == "OVRLRESP" )
The first step involves company-specific pre-processing of records for
the required input to the downstream parameter functions. Note that this
could be needed multiple times (e.g. once for investigator and once for
Independent Review Facility (IRF)/Blinded Independent Central Review
(BICR) records). It could even involve merging input data from other
sources besides RS
, such as ADTR
.
This step would include any required selection/derivation of ADT
or
applying any necessary partial date imputations, updating AVAL
(e.g.
this should be ordered from best to worst response), and setting
analysis flag ANL01FL
. Common options for ANL01FL
would be to set
null for invalid assessments or those occurring after new anti-cancer
therapy, or to only flag assessments on or after after date of first
treatment/randomization, or rules to cover the case when a patient has
multiple observations per visit (e.g. by selecting worst value). Another
consideration could be extra potential protocol-specific sources of
Progressive Disease such as radiological assessments, which could be
pre-processed here to create a PD record to feed downstream derivations.
For the derivation of the parameters it is expected that the subject
identifier variables (usually STUDYID
and USUBJID
) and ADT
are a
unique key. This can be achieved by deriving an analysis flag
(ANLzzFL
). See Derive ANL01FL
for an example.
The below shows an example of a possible company-specific implementation of this step.
In this case we use the overall response records from RS
from the
investigator as our starting point. The parameter details such as
PARAMCD
, PARAM
etc will always be company-specific, but an example
is shown below so that you can trace through how these records feed into
the other parameter derivations.
adrs <- adrs %>% filter(RSEVAL == "INVESTIGATOR" & RSTESTCD == "OVRLRESP") %>% mutate( PARAMCD = "OVR", PARAM = "Overall Response by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1" )
dataset_vignette( adrs, display_vars = exprs(USUBJID, VISIT, RSTESTCD, RSEVAL, PARAMCD, PARAM, PARCAT1, PARCAT2, PARCAT3) )
ADT
, ADTF
, AVISIT
etcIf your data collection allows for partial dates, you could apply a
company-specific imputation rule at this stage when deriving ADT
. For
this example, here we impute missing day to last possible date.
adrs <- adrs %>% derive_vars_dt( dtc = RSDTC, new_vars_prefix = "A", highest_imputation = "D", date_imputation = "last" ) %>% mutate(AVISIT = VISIT)
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, RSSTRESC, RSDTC, ADT, ADTF) )
AVALC
and AVAL
Here we populate AVALC
and create the numeric version as AVAL
(ordered from best to worst response). This ordering is already covered
within our RECIST v1.1 parameter derivation functions, and so changing
AVAL
here would not change the result of those derivations.
adrs <- adrs %>% mutate( AVALC = RSSTRESC, AVAL = aval_resp(AVALC) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, RSSTRESC, AVALC, AVAL) )
ANL01FL
) {#anl01fl}When deriving ANL01FL
this is an opportunity to exclude any records
that should not contribute to any downstream parameter derivations. In
the below example this includes only selecting valid assessments and
those occurring on or after randomization date. If there is more than
one assessment at a date, the worst one is flagged.
worst_resp <- function(arg) { case_when( arg == "NE" ~ 1, arg == "CR" ~ 2, arg == "PR" ~ 3, arg == "SD" ~ 4, arg == "NON-CR/NON-PD" ~ 5, arg == "PD" ~ 6, TRUE ~ 0 ) } adrs <- adrs %>% restrict_derivation( derivation = derive_var_extreme_flag, args = params( by_vars = c(get_admiral_option("subject_keys"), exprs(ADT)), order = exprs(worst_resp(AVALC), RSSEQ), new_var = ANL01FL, mode = "last" ), filter = !is.na(AVAL) & ADT >= RANDDT )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, RANDDT, ANL01FL) )
Here is an alternative example where those records occurring after new
anti-cancer therapy are additionally excluded (where NACTDT
would be
pre-derived as first date of new anti-cancer therapy. See {admiralonco}
Creating and Using New Anti-Cancer Start Date for deriving this variable).
adrs <- adrs %>% mutate( ANL01FL = case_when( !is.na(AVAL) & ADT >= RANDDT & ADT < NACTDT ~ "Y", TRUE ~ NA_character_ ) )
Note here that we don't filter out records after first PD
at this
stage, as that is specifically catered for in the {admiralonco}
parameter derivation functions in the below steps, via source_pd
arguments.
ANL02FL
) {#anl02fl}However, if you prefer not to rely on source_pd
arguments,
then the user is free to filter out records after first PD
at this
stage in a similar way via a ANLzzFL
flag, and then you could leave
source_pd
as null in all downstream parameter derivation function
calls. So, for example the user could create ANL02FL
flag to subset
the post-baseline response data up to and including first reported
progressive disease. This would be an alternative and transparent method
to the use of source_pd
argument approach to create ADRS parameters
below. Using {admiral}
function admiral::derive_var_relative_flag()
we could create ANL02FL
as below.
adrs <- adrs %>% derive_var_relative_flag( by_vars = get_admiral_option("subject_keys"), order = exprs(ADT, RSSEQ), new_var = ANL02FL, condition = AVALC == "PD", mode = "first", selection = "before", inclusive = TRUE )
Now that we have the input records prepared above with any
company-specific requirements, we can start to derive new parameter
records. For the parameter derivations, all values except those
overwritten by set_values_to
argument are kept from the earliest
occurring input record fulfilling the required criteria.
The function admiral::derive_extreme_records()
can be used to find
the date of first PD
.
adrs <- adrs %>% derive_extreme_records( dataset_ref = adsl, dataset_add = adrs, by_vars = get_admiral_option("subject_keys"), filter_add = PARAMCD == "OVR" & AVALC == "PD" & ANL01FL == "Y", order = exprs(ADT, RSSEQ), mode = "first", exist_flag = AVALC, false_value = "N", set_values_to = exprs( PARAMCD = "PD", PARAM = "Disease Progression by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, ANL01FL), filter = PARAMCD == "PD" )
For progressive disease, response and death parameters shown in steps
here and below, in our examples we show these as ADRS
parameters, but
they could equally be achieved via ADSL
dates or ADEVENT
parameters.
If you prefer to store as an ADSL date, then the function
admiral::derive_var_extreme_dt()
could be used to find the date of
first PD
as a variable, rather than as a new parameter record. All the
parameter derivation functions that use these dates are flexible to
allow sourcing these from any input source using
admiral::date_source()
. See examples below.
The next required step is to define the source location for this newly
derived PD
date.
pd <- date_source( dataset_name = "adrs", date = ADT, filter = PARAMCD == "PD" & AVALC == "Y" )
An equivalent example if using ADSL
instead could be as follows (where
PDDT
would be pre-derived as first date of progressive disease).
pd <- date_source( dataset_name = "adsl", date = PDDT )
The function derive_param_response()
can then be used to find the date of
first response. This differs from the admiral::derive_extreme_records()
function in that it only looks for events occurring prior to first PD
. In the
below example, the response condition has been defined as CR
or PR
.
adrs <- adrs %>% derive_param_response( dataset_adsl = adsl, filter_source = PARAMCD == "OVR" & AVALC %in% c("CR", "PR") & ANL01FL == "Y", source_pd = pd, source_datasets = list(adrs = adrs), set_values_to = exprs( PARAMCD = "RSP", PARAM = "Response by Investigator (confirmation not required)", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, ANL01FL), filter = PARAMCD == "RSP" )
Similarly, we now define the source location for this newly derived first response date.
resp <- date_source( dataset_name = "adrs", date = ADT, filter = PARAMCD == "RSP" & AVALC == "Y" )
The function derive_param_clinbenefit()
can then be used to derive the
clinical benefit parameter, which we define as a patient having had a
response or a sustained period of time before first PD
. This could
also be known as disease control. In this example the "sustained period"
has been defined as 42 days after randomization date, using the
ref_start_window
argument.
adrs <- adrs %>% derive_param_clinbenefit( dataset_adsl = adsl, filter_source = PARAMCD == "OVR" & ANL01FL == "Y", source_resp = resp, source_pd = pd, source_datasets = list(adrs = adrs), reference_date = RANDDT, ref_start_window = 42, set_values_to = exprs( PARAMCD = "CB", PARAM = "Clinical Benefit by Investigator (confirmation for response not required)", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, RANDDT, ANL01FL), filter = PARAMCD == "CB" )
The function derive_param_bor()
can be used to derive the best overall
response (without confirmation required) parameter. Similar to the above
function you can optionally decide what period would you consider a SD
or NON-CR/NON-PD
as being eligible from. In this example, 42 days
after randomization date has been used again.
adrs <- adrs %>% derive_param_bor( dataset_adsl = adsl, filter_source = PARAMCD == "OVR" & ANL01FL == "Y", source_pd = pd, source_datasets = list(adrs = adrs), reference_date = RANDDT, ref_start_window = 42, set_values_to = exprs( PARAMCD = "BOR", PARAM = "Best Overall Response by Investigator (confirmation not required)", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = aval_resp(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, RANDDT, ANL01FL), filter = PARAMCD == "BOR" )
Note that the above gives pre-defined AVAL
values (defined by aval_resp()
)
of: "CR" ~ 1
, "PR" ~ 2
, "SD" ~ 3
, "NON-CR/NON-PD" ~ 4
, "PD" ~ 5
, "NE"
~ 6
, "MISSING" ~ 7
.
If you'd like to provide your own company-specific ordering here you could do this as follows:
aval_resp_new <- function(arg) { case_when( arg == "CR" ~ 7, arg == "PR" ~ 6, arg == "SD" ~ 5, arg == "NON-CR/NON-PD" ~ 4, arg == "PD" ~ 3, arg == "NE" ~ 2, arg == "MISSING" ~ 1, TRUE ~ NA_real_ ) }
Then update the definition of AVAL
in the set_values_to
argument of the
above derive_param_bor()
call. Be aware that this will only impact the AVAL
mapping, not the derivation of BOR in any way - as the function derivation
relies only on AVALC
here.
The function admiral::derive_extreme_records()
can be used to check if a
patient had a response for BOR.
adrs <- adrs %>% derive_extreme_records( dataset_ref = adsl, dataset_add = adrs, by_vars = get_admiral_option("subject_keys"), filter_add = PARAMCD == "BOR" & AVALC %in% c("CR", "PR"), order = exprs(ADT, RSSEQ), mode = "first", exist_flag = AVALC, false_value = "N", set_values_to = exprs( PARAMCD = "BCP", PARAM = "Best Overall Response of CR/PR by Investigator (confirmation not required)", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, ANL01FL), filter = PARAMCD == "BCP" )
Any of the above response parameters can be repeated for "confirmed"
responses only. For these the functions derive_param_confirmed_resp()
and derive_param_confirmed_bor()
can be used. Some of the other
functions from above can then be re-used passing in these confirmed
response records. See the examples below of derived parameters requiring
confirmation. The assessment and the confirmatory assessment here need
to occur at least 28 days apart (without any +1 applied to this
calculation of days between visits), using the ref_confirm
argument.
adrs <- adrs %>% derive_param_confirmed_resp( dataset_adsl = adsl, filter_source = PARAMCD == "OVR" & ANL01FL == "Y", source_pd = pd, source_datasets = list(adrs = adrs), ref_confirm = 28, set_values_to = exprs( PARAMCD = "CRSP", PARAM = "Confirmed Response by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) ) confirmed_resp <- date_source( dataset_name = "adrs", date = ADT, filter = PARAMCD == "CRSP" & AVALC == "Y" ) adrs <- adrs %>% derive_param_clinbenefit( dataset_adsl = adsl, filter_source = PARAMCD == "OVR" & ANL01FL == "Y", source_resp = confirmed_resp, source_pd = pd, source_datasets = list(adrs = adrs), reference_date = RANDDT, ref_start_window = 42, set_values_to = exprs( PARAMCD = "CCB", PARAM = "Confirmed Clinical Benefit by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) ) %>% derive_param_confirmed_bor( dataset_adsl = adsl, filter_source = PARAMCD == "OVR" & ANL01FL == "Y", source_pd = pd, source_datasets = list(adrs = adrs), reference_date = RANDDT, ref_start_window = 42, ref_confirm = 28, set_values_to = exprs( PARAMCD = "CBOR", PARAM = "Best Confirmed Overall Response by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = aval_resp(AVALC), ANL01FL = "Y" ) ) %>% derive_extreme_records( dataset_ref = adsl, dataset_add = adrs, by_vars = get_admiral_option("subject_keys"), filter_add = PARAMCD == "CBOR" & AVALC %in% c("CR", "PR"), order = exprs(ADT, RSSEQ), mode = "first", exist_flag = AVALC, false_value = "N", set_values_to = exprs( PARAMCD = "CBCP", PARAM = "Best Confirmed Overall Response of CR/PR by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, RANDDT, ANL01FL), filter = PARAMCD %in% c("CRSP", "CCB", "CBOR", "CBCP") )
All of the above steps can be repeated for different sets of records, such as now using assessments from the IRF/BICR instead of investigator. For this you would just need to replace the first steps with selecting the required records, and then feed these as input to the downstream parameter functions.
Remember that a new progressive disease and response source object would
be required for passing to source_pd
and source_resp
respectively.
adrs_bicr <- rs %>% filter( RSEVAL == "INDEPENDENT ASSESSOR" & RSACPTFL == "Y" & RSTESTCD == "OVRLRESP" ) %>% mutate( PARAMCD = "OVRB", PARAM = "Overall Response by BICR", PARCAT1 = "Tumor Response", PARCAT2 = "Blinded Independent Central Review", PARCAT3 = "RECIST 1.1" )
dataset_vignette( adrs_bicr, display_vars = exprs(USUBJID, VISIT, RSTESTCD, RSEVAL, PARAMCD, PARAM, PARCAT1, PARCAT2, PARCAT3), filter = PARAMCD == "OVRR1" )
Then in all the calls to the parameter derivation functions you would
replace the PARAMCD == "OVR"
source with PARAMCD == "OVRR1"
.
The function admiral::derive_extreme_records()
can be used to create
a new death parameter using death date from ADSL
. We need to restrict
the columns from ADSL
as we'll merge all required variables later
across all our ADRS
records.
adsldth <- adsl %>% select(!!!get_admiral_option("subject_keys"), DTHDT, !!!adsl_vars) adrs <- adrs %>% derive_extreme_records( dataset_ref = adsldth, dataset_add = adsldth, by_vars = get_admiral_option("subject_keys"), filter_add = !is.na(DTHDT), exist_flag = AVALC, false_value = "N", set_values_to = exprs( PARAMCD = "DEATH", PARAM = "Death", PARCAT1 = "Reference Event", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y", ADT = DTHDT ) ) %>% select(-DTHDT)
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, ANL01FL), filter = PARAMCD == "DEATH" )
The function admiral::derive_extreme_records()
can be used to create a
parameter for last disease assessment.
adrs <- adrs %>% derive_extreme_records( dataset_ref = adsl, dataset_add = adrs, by_vars = get_admiral_option("subject_keys"), filter_add = PARAMCD == "OVR" & ANL01FL == "Y", order = exprs(ADT, RSSEQ), mode = "last", set_values_to = exprs( PARAMCD = "LSTA", PARAM = "Last Disease Assessment by Investigator", PARCAT1 = "Tumor Response", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, ANL01FL), filter = PARAMCD == "LSTA" )
The function admiral::derive_param_exist_flag()
can be used to check
whether a patient has measurable disease at baseline, according to a
company-specific condition. In this example we check TU
for target
lesions during the baseline visit. We need to restrict the columns from
ADSL
as we'll merge all required variables later across all our ADRS
records.
adslmdis <- adsl %>% select(!!!get_admiral_option("subject_keys"), !!!adsl_vars) adrs <- adrs %>% derive_param_exist_flag( dataset_ref = adslmdis, dataset_add = tu, condition = TUEVAL == "INVESTIGATOR" & TUSTRESC == "TARGET" & VISIT == "SCREENING", false_value = "N", missing_value = "N", set_values_to = exprs( PARAMCD = "MDIS", PARAM = "Measurable Disease at Baseline by Investigator", PARCAT2 = "Investigator", PARCAT3 = "RECIST 1.1", AVAL = yn_to_numeric(AVALC), ANL01FL = "Y" ) )
dataset_vignette( adrs, display_vars = exprs(USUBJID, AVISIT, PARAMCD, PARAM, AVALC, ADT, ANL01FL), filter = PARAMCD == "MDIS" )
ASEQ
{#aseq}The function admiral::derive_var_obs_number()
can be used to derive
ASEQ
. An example call is:
adrs <- adrs %>% derive_var_obs_number( by_vars = get_admiral_option("subject_keys"), order = exprs(PARAMCD, ADT, VISITNUM, RSSEQ), check_type = "error" )
dataset_vignette( adrs, display_vars = exprs(USUBJID, PARAMCD, ADT, VISITNUM, AVISIT, ASEQ), filter = USUBJID == "01-701-1015" )
If needed, the other ADSL
variables can now be added. List of ADSL
variables already merged held in vector adsl_vars
.
adrs <- adrs %>% derive_vars_merged( dataset_add = select(adsl, !!!negate_vars(adsl_vars)), by_vars = get_admiral_option("subject_keys") )
dataset_vignette( adrs, display_vars = exprs(USUBJID, RFSTDTC, RFENDTC, DTHDTC, DTHFL, AGE, AGEU), filter = USUBJID == "01-701-1015" )
ADaM | Sample Code
---- | --------------
ADRS_BASIC | admiral::use_ad_template("ADRS_BASIC", package = "admiralonco")
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