Factors associated with failure of oncology drugs in late-stage clinical development: A systematic review

被引:71
作者
Jardim, Denis L. [1 ]
Groves, Eric S. [2 ]
Breitfeld, Philip P. [3 ]
Kurzrock, Razelle [4 ,5 ]
机构
[1] Hosp Sirio Libanes, Dept Clin Oncol, Adma Jafet St 91, BR-01308050 Sao Paulo, Brazil
[2] Quintiles Pharmaceut, Durham, NC USA
[3] Breitfeld Grp LLC, Chapel Hill, NC USA
[4] Univ Calif San Diego, Ctr Personalized Canc Therapy, San Diego, CA 92103 USA
[5] Univ Calif San Diego, Div Hematol & Oncol, San Diego, CA 92103 USA
关键词
Drug development; Precision medicine; Phase III trials; Biomarker; FDA; CELL LUNG-CANCER; PHASE-III TRIALS; METASTATIC BREAST-CANCER; DOUBLE-BLIND; DISCONTINUED DRUGS; RADIATION-THERAPY; RANDOMIZED-TRIALS; PROSTATE-CANCER; CARBOPLATIN; PLACEBO;
D O I
10.1016/j.ctrv.2016.10.009
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: We aimed to describe the reasons for failure of experimental anticancer drugs in late-stage clinical development. Material and methods: We searched the PharmaProjects database (https://citeline.com/products/pharmaprojects/) for anticancer drugs discontinued between 01(01/2009 and 06/30/2014. Drug programs that reached phase III trials, but never gained Food and Drug Administration (FDA) approval were compared to 37 anti-cancer drugs achieving FDA approval in this time period. Results: Forty-two drugs fit our criteria for development failures. These failed drugs (49% targeted, 23% cytotoxics, and 28% other) were tested in 43 cancer indications (drug programs). Only 16% (7/43) of failed drug programs adopted a biomarker-driven rationale for patient selection versus 57% (21/37) of successful drug programs (P < 0.001). Phase II trial information was available in 32 of 43 failed drug programs and in 32 of 37 successful programs. Nine of the 32 trials (28%) of failed drugs versus 28 of 32 trials (87%) of successful drugs (P < 0.001) achieved proof of concept (single agent response rate (RR) >= 20% or combination therapy showing a >= 20% RR increase above the median historical RR without the experimental agent (with a minimal absolute increase of 5%) or a randomized phase II trial showing significance (P <= 0.05) for its primary outcome). No pattern of study sites, trial design or funding characteristics emerged from the failed drug analysis. Conclusion: For drugs that reached Phase III, lack of a biomarker-driven strategy and failure to attain proof of concept in phase II are potential risk factors for later discontinuation, especially for targeted agents. (C) 2016 Elsevier Ltd. All rights reserved.
引用
收藏
页码:12 / 21
页数:10
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