Emilie Lanoy

Perrine Chassat, Van Tuan Nguyen, Lucas Ducrot et al.

Clinical trials face mounting challenges: fragmented patient populations, slow enrollment, and unsustainable costs, particularly for late phase trials in oncology and rare diseases. While external control arms built from real-world data have been explored, a promising alternative is the generation of synthetic control arms using generative AI. A central challenge is the generation of time-to-event outcomes, which constitute primary endpoints in oncology and rare disease trials, but are difficult to model under censoring and small sample sizes. Existing generative approaches, largely GAN-based, are data-hungry, unstable, and rely on strong assumptions such as independent censoring. We introduce a variational autoencoder (VAE) that jointly generates mixed-type covariates and survival outcomes within a unified latent variable framework, without assuming independent censoring. Across synthetic and real trial datasets, we evaluate our model in two realistic scenarios: (i) data sharing under privacy constraints, where synthetic controls substitute for original data, and (ii) control-arm augmentation, where synthetic patients mitigate imbalances between treated and control groups. Our method outperforms GAN baselines on fidelity, utility, and privacy metrics, while revealing systematic miscalibration of type I error and power. We propose a post-generation selection procedure that improves calibration, highlighting both progress and open challenges for generative survival modeling.

Vahé Asvatourian, Clélia Coutzac, Nathalie Chaput et al.

Recently, the intervention calculus when the DAG is absent (IDA) method was developed to estimate lower bounds of causal effects from observational high-dimensional data. Originally it was introduced to assess the effect of baseline biomarkers which do not vary over time. However, in many clinical settings, measurements of biomarkers are repeated at fixed time points during treatment exposure and, therefore, this method need to be extended. The purpose of this paper is then to extend the first step of the IDA, the Peter Clarks (PC)-algorithm, to a time-dependent exposure in the context of a binary outcome. We generalised the PC-algorithm for taking into account the chronological order of repeated measurements of the exposure and propose to apply the IDA with our new version, the chronologically ordered PC-algorithm (COPC-algorithm). A simulation study has been performed before applying the method for estimating causal effects of time-dependent immunological biomarkers on toxicity, death and progression in patients with metastatic melanoma. The simulation study showed that the completed partially directed acyclic graphs (CPDAGs) obtained using COPC-algorithm were structurally closer to the true CPDAG than CPDAGs obtained using PC-algorithm. Also, causal effects were more accurate when they were estimated based on CPDAGs obtained using COPC-algorithm. Moreover, CPDAGs obtained by COPC-algorithm allowed removing non-chronologic arrows with a variable measured at a time t pointing to a variable measured at a time t' where t'< t. Bidirected edges were less present in CPDAGs obtained with the COPC-algorithm, supporting the fact that there was less variability in causal effects estimated from these CPDAGs. The COPC-algorithm provided CPDAGs that keep the chronological structure present in the data, thus allowed to estimate lower bounds of the causal effect of time-dependent biomarkers.