Evaluating the FDA’s Approach to Cancer Clinical Trials


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Given the recent advances in our understanding of cancer and our improved technologic capabilities, we are now placing an emphasis on evaluating how we design clinical trials to make the system more efficient, to more rapidly deliver safe and effective products for patients.
— Richard Pazdur, MD

Since the announcement of the U.S. Food and Drug Administration (FDA) Oncology Center of Excellence (OCE) on June 29, 2016, as part of the White House’s Cancer Moonshot, we’ve been working to further the FDA’s efforts to get new oncology products into the hands of patients. We are committed to meeting the needs of patients and health-care communities by driving progress in the prevention, diagnosis, and treatment of cancer.

At the core of the OCE’s work—and of the Cancer Moonshot—is taking a new look at what we have been doing in the past so we can operate more efficiently in the future. The OCE will leverage the combined skills of oncologists and scientists with expertise in drugs, biologics, and devices to employ the best and most innovative approaches to bring forth safe new oncology products.

More Efficient Trials

The vision set forth by the Vice President underscores our commitment to optimally designed clinical trials that efficiently provide answers to important questions. Given the recent advances in our understanding of cancer and our improved technologic capabilities, we are now placing an emphasis on evaluating how we design clinical trials to make the system more efficient, to more rapidly deliver safe and effective products for patients.

We are working with stakeholders across government and industry to revisit the criteria used for determining whether a patient is eligible to participate in a trial. Modifying the eligibility criteria could expand the number of people who qualify and therefore open new opportunities for participation and enhance the generalizability of what we learn. Of course, regardless of adjustments, patient safety will remain paramount.

We recently published our perspective1 on shifting away from the conventional phase I, phase II, and phase III drug development paradigm to a more seamless approach that could expedite the regulatory pathway, providing earlier access to highly effective therapeutic drugs. Adopting this approach could complement the FDA’s expedited regulatory programs such as Breakthrough Therapy designation and accelerated approval to get products to patients in the most efficient manner possible.

Other Research Initiatives

Another initiative is the use of common control trials. These trials, sharing a common control arm, involve multiple different drugs for the same indication and may involve different companies. When a common control arm is used, it decreases the overall number of patients that need to be recruited and enrolled, optimizing clinical trial resources and potentially decreasing the time it takes to get a new study off the ground.

Encouraging the use of large simple trials is another way to make more efficient use of clinical trial resources. These trials generally use easily measured endpoints that are well understood, optimizing the collection of data for safety or secondary efficacy endpoints and thus reducing the amount of data needed compared to conventional randomized trials.

Greater Collaboration

As befits the Center of Excellence, one of our top goals is striving for excellence both in drug and device regulation and in emerging oncology science. To achieve that goal, we must also collaborate with academia, industry, patient groups, professional societies, and other international regulators. We have already begun this work by scheduling several public meetings,2 which will provide a forum to interact with patients and other stakeholders.

These initiatives will allow us to expedite drug development and approval of truly novel agents that will have a major impact on our patients, while allowing us to make thoughtful decisions regarding the risk-benefit of oncology drugs. ■

References

1. Prowell TM, Theoret MR, Pazdur R: Perspective: Seamless oncology-drug development. N Engl J Med 374:2001-2003, 2016.

2. U.S. Food and Drug Administration: Oncology Center of Excellence. Available at http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/ucm509057.htm. Accessed October 5, 2016.



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