The Minimum Detectable Difference (MDD) Concept for Establishing Trust in Nonsignificant Results: A Critical Review

Current regulatory guidelines for pesticide risk assessment recommend that nonsignificant results should be complemented by the minimum detectable difference (MDD), a statistical indicator that is used to decide whether the experiment could have detected biologically relevant effects. We review the statistical theory of the MDD and perform simulations to understand its properties and error rates. Most importantly, we compare the skill of the MDD in distinguishing between true and false negatives (i.e., type II errors) with 2 alternatives: the minimum detectable effect (MDE), an indicator based on a post hoc power analysis common in medical studies; and confidence intervals (CIs). Our results demonstrate that MDD and MDE only differ in that the power of the MDD depends on the sample size. Moreover, although both MDD and MDE have some skill in distinguishing between false negatives and true absence of an effect, they do not perform as well as using CI upper bounds to establish trust in a nonsignificant result. The reason is that, unlike the CI, neither MDD nor MDE consider the estimated effect size in their calculation. We also show that MDD and MDE are no better than CIs in identifying larger effects among the false negatives. We conclude that, although MDDs are useful, CIs are preferable for deciding whether to treat a nonsignificant test result as a true negative, or for determining an upper bound for an unknown true effect.Environ Toxicol Chem2020;00:1-15. (c) 2020 The Authors.Environmental Toxicology and Chemistrypublished by Wiley Periodicals LLC on behalf of SETAC

Treg Depletion Inhibits Efficacy of Cancer Immunotherapy: Implications for Clinical Trials

Regulatory T lymphocytes (Treg) infiltrate human glioblastoma (GBM); are involved in tumor progression and correlate with tumor grade. Transient elimination of Tregs using CD25 depleting antibodies (PC61) has been found to mediate GBM regression in preclinical models of brain tumors. Clinical trials that combine Treg depletion with tumor vaccination are underway to determine whether transient Treg depletion can enhance anti-tumor immune responses and improve long term survival in cancer patients.Using a syngeneic intracrabial glioblastoma (GBM) mouse model we show that systemic depletion of Tregs 15 days after tumor implantation using PC61 resulted in a decrease in Tregs present in tumors, draining lymph nodes and spleen and improved long-term survival (50% of mice survived >150 days). No improvement in survival was observed when Tregs were depleted 24 days after tumor implantation, suggesting that tumor burden is an important factor for determining efficacy of Treg depletion in clinical trials. In a T cell dependent model of brain tumor regression elicited by intratumoral delivery of adenoviral vectors (Ad) expressing Fms-like Tyrosine Kinase 3 ligand (Flt3L) and Herpes Simplex Type 1-Thymidine Kinase (TK) with ganciclovir (GCV), we demonstrate that administration of PC61 24 days after tumor implantation (7 days after treatment) inhibited T cell dependent tumor regression and long term survival. Further, depletion with PC61 completely inhibited clonal expansion of tumor antigen-specific T lymphocytes in response to the treatment.Our data demonstrate for the first time, that although Treg depletion inhibits the progression/eliminates GBM tumors, its efficacy is dependent on tumor burden. We conclude that this approach will be useful in a setting of minimal residual disease. Further, we also demonstrate that Treg depletion, using PC61 in combination with immunotherapy, inhibits clonal expansion of tumor antigen-specific T cells, suggesting that new, more specific targets to block Tregs will be necessary when used in combination with therapies that activate anti-tumor immunity