Predicting therapeutic clinical trial enrollment for adult patients with low- and high-grade glioma using supervised machine learning.

Journal: Science advances
Published Date: Jun 4, 2025

Abstract

Therapeutic clinical trial enrollment does not match glioma incidence across demographics. Traditional statistical methods have identified independent predictors of trial enrollment; however, our understanding of the interactions between these factors remains limited. To test the interactive effects of demographic, socioeconomic, and oncologic variables on trial enrollment, we designed boosted neural networks (BNNs) for all glioma patients ( = 1042), women ( = 445, 42.7%), and minorities ( = 151, 14.5%) and externally validated these models [whole cohort,  = 230; women,  = 89 (38.7%); minority,  = 66 (28.7%)]. For the whole-cohort BNN, the most influential variables on enrollment were oncologic variables, including KPS [total effect (TE), 0.327], chemotherapy (TE, 0.326), tumor location (TE, 0.322), and seizures (TE, 0.239). The women-only BNN exhibited a similar trend. Conversely, for the minority-only BNN, socioeconomic variables [insurance status (TE, 0.213), occupation classification (TE, 0.204), and employment status (TE, 0.150)] were most influential. These results may help prioritize patient-specific initiatives to increase accrual.

Authors

  • Mulki Mehari
    Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
  • Gayathri Warrier
    Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA.
  • Abraham Dada
    Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
  • Aymen Kabir
    Department of Neurological Surgery, University of California, San Francisco, California, USA.
  • Aden P Haskell-Mendoza
    Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
  • Arushi Tripathy
    Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI 48109, USA.
  • Rohan Jha
    Harvard Medical School, Boston, MA 02115, USA.
  • Edwin Nieblas-Bedolla
    Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI 48109, USA.
  • Joshua D Jackson
    Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
  • Ariel T Gonzalez
    Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
  • Ellery H Reason
    Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
  • Ann Marie Flusche
    Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
  • Sheantel Reihl
    Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA 90095, USA.
  • Tara Dalton
    School of Medicine, Duke University, Durham, NC, USA.
  • Mikias Negussie
    Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA.
  • Cesar Nava Gonzales
    Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA.
  • Vardhaan S Ambati
    Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA.
  • Annick Desjardins
    Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
  • Andy G S Daniel
    Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA.
  • Saritha Krishna
    Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA.
  • Susan Chang
    Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
  • Alyx Porter
    Division of Neuro-Oncology, Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA.
  • Peter E Fecci
    Departments of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
  • Todd Hollon
    Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA.
  • Ugonma N Chukwueke
    Center for Neuro-Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
  • Kimberly Badal
    Department of Surgery, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.
  • Annette M Molinaro
    Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
  • Shawn L Hervey-Jumper
    Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.

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