We show that semiparametric profile likelihoods, where the nuisance parameter has been profiled out, behave like ordinary likelihoods in that they have a quadratic expansion. In this expansion the score function and the Fisher information are replaced by the efficient score function and efficient Fisher information. The expansion may be used, among others, to prove the asymptotic normality of the maximum likelihood estimator, to derive the asymptotic chi-squared distribution of the log-likelihood ratio statistic, and to prove the consistency of the observed information as an estimator of the inverse of the asymptotic variance.

A dynamic treatment regime is a list of rules for how the level of treatment will be tailored through time to an individual's changing severity. In general, individuals who receive the highest level of treatment are the individuals with the greatest severity and need for treatment. Thus there is planned selection of the treatment dose. In addition to the planned selection mandated by the treatment rules, the use of staff judgment results in unplanned selection of the treatment level. Given observational longitudinal data or data in which there is unplanned selection, of the treatment level, the methodology proposed here allows the estimation of a mean response to a dynamic treatment regime under the assumption of sequential randomization.

BackgroundPersonalized, precision, P4, or stratified medicine is understood as a medical approach in which patients are stratified based on their disease subtype, risk, prognosis, or treatment response using specialized diagnostic tests. The key idea is to base medical decisions on individual patient characteristics, including molecular and behavioral biomarkers, rather than on population averages. Personalized medicine is deeply connected to and dependent on data science, specifically machine learning (often named Artificial Intelligence in the mainstream media). While during recent years there has been a lot of enthusiasm about the potential of ‘big data’ and machine learning-based solutions, there exist only few examples that impact current clinical practice. The lack of impact on clinical practice can largely be attributed to insufficient performance of predictive models, difficulties to interpret complex model predictions, and lack of validation via prospective clinical trials that demonstrate a clear benefit compared to the standard of care. In this paper, we review the potential of state-of-the-art data science approaches for personalized medicine, discuss open challenges, and highlight directions that may help to overcome them in the future.ConclusionsThere is a need for an interdisciplinary effort, including data scientists, physicians, patient advocates, regulatory agencies, and health insurance organizations. Partially unrealistic expectations and concerns about data science-based solutions need to be better managed. In parallel, computational methods must advance more to provide direct benefit to clinical practice.

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