In many clinical trials, a single endpoint is used to answer the primary question and
forms the basis for monitoring the experimental therapy. Many trials are lengthy in duration and
investigators are interested in using an intermediate endpoint for an accelerated approval, but will
rely on the primary endpoint (such as, overall survival) for the full approval of the drug by the
Food and Drug Administration. We have designed a clinical trial where both intermediate
(progression-free survival, (PFS)) and primary endpoints (overall survival, (OS)) are used for
monitoring the trial so the overall type I error rate is preserved at the pre-specified alpha level
of 0.05. A two-stage procedure is used. In the first stage, the Bonferroni correction was used where
the global type I error rate was allocated to each of the endpoints. In the next stage, the
O’Brien-Fleming approach was used to design the boundary for the interim and final analysis
for each endpoint. Data were generated assuming several parametric copulas with exponential
marginals. Different degrees of dependence, as measured by Kendall’s
τ, between OS and PFS were assumed: 0 (independence) 0.3, 0.5 and 0.70.
This approach is applied to an example in a prostate cancer trial.