Economic growth of BRIC nations and access to early-phase oncology clinical trials: An overview.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17554-e17554
Author(s):  
Heloisa Veasey Rodrigues ◽  
Prasanth Ganesan ◽  
Xiaochun Liu ◽  
Vivek Subbiah
Keyword(s):  
Economic Growth ◽  
Clinical Trials ◽  
Early Phase ◽  
Kinase Inhibitors ◽  
Current Status ◽  
The Road ◽  
Bric Countries ◽  
Oncology Clinical Trials ◽  
Early Phase Clinical Trials ◽  
The Impact

e17554 Background: With increasing globalization we have witnessed exponential economic growth in the BRIC (Brazil, Russia, India and China) nations. Concurrently, clinical trials have been outsourced to these countries. We sought to investigate the current status of early phase oncology clinical trials in the BRIC countries, exemplifying the impact of these emerging economies and global markets in health care. Methods: We reviewed the clinicaltrials.gov database for registered early phase trials (Phase I/II) in the BRIC countries; 2. We looked at research from these countries collectively. 3. We reviewed specific challenges and prognosticated the road ahead through a literature review. Results: We identified374 active early phase clinical trials in BRIC countries as of October 2012. China had 68% (255/374) of the trials, Brazil 14% (51/374), Russia 12% (47/374) and India 6% (21/374). Twenty-three trials were registered in more than one BRIC; therefore we analyzed 348 different trials. Gastrointestinal (20%, 70/348), lung (19%, 67/348) and breast (17%, 57/348) cancers were the most studied. Most of the trials were sponsored by universities or hospitals (51%, 176/348) and most conducted in a single country (73%, 247/348) with 70% of therapy intended to be palliative (243/348). Combined agents were most commonly studied (57%, 199/348). Among the 217 targeted-agent trials, 23% targeted the EGFR pathway, 18% the VEGFR, 11% involved multi-tyrosine kinase inhibitors and 10% the PI3K-mTOR pathway. Funding mechanisms and sponsorship of studies were disparate. Industry-sponsored studies comprised 24% (62/255) in China, 96% (45/47) in Russia, 80% (41/51) in Brazil and 57% (12/21) in India. Conclusions: Despite theeconomic explosion and shift of non-oncology clinical trials to BRIC nations, USA and Europe still lead in conducting early phase clinical trials in oncology. China accounts for 19% of world’s population and has the majority (68%) of trials while India (17% of World’s population) has only 6%. A dominance of industry-sponsored studies in BRIC countries other than China was found. Significant challenges in infrastructure and trained personnel remain, but efforts to overcome them are underway.

Current Status of Patient-Reported Outcomes in Industry-Sponsored Oncology Clinical Trials and Product Labels

2007 ◽  
Vol 25 (32) ◽  
pp. 5087-5093 ◽  
Author(s):  
Kathleen Gondek ◽  
Pierre-Philippe Sagnier ◽  
Kim Gilchrist ◽  
J. Michael Woolley
Keyword(s):  
Clinical Trials ◽  
Patient Reported Outcomes ◽  
Symptom Assessment ◽  
Current Status ◽  
Cancer Therapies ◽  
Package Inserts ◽  
Patient Reported ◽  
Oncology Clinical Trials ◽  
Related Quality ◽  
The Impact

Assessing patient-reported outcomes (PROs) in clinical trials is of interest to clinicians, patients, regulators, and industry. The use and impact of PROs is a growing area of methodologic research, particularly as they relate to tumor types, biomarkers, and various patient populations and cultures. Both the US Food and Drug Administration (FDA) and European Agency for the Evaluation of Medicinal Products in recent guidance have acknowledged the need to account for treatment-related impact on patient symptoms and/or health-related quality of life (HRQOL). Clinical research likely reflects the informative value of PROs. A search of www.clinicaltrials.gov , the FDA Web site, and product package inserts was conducted to assess the inclusion of symptom assessment and HRQOL within industry-sponsored clinical trials in cancer and approved cancer therapies and their respective product labels. Overall, there were 2,704 industry-sponsored oncology trials, of which 322 (12%) included a PRO measure. Of the 70 FDA new or revised labels, only six package inserts include PRO data. Symptoms were assessed uniformly across the phases of clinical trials, whereas HRQOL assessment increased in the later phases of clinical trials. Collecting PRO data can enhance our understanding of cancer burden and the impact of interventions on patients' lives.

Monitoring event times in early phase clinical trials: some practical issues

2005 ◽  
Vol 2 (6) ◽  
pp. 467-478 ◽  
Author(s):  
Peter F Thall ◽  
Leiko H Wooten ◽  
Nizar M Tannir
Keyword(s):  
Clinical Trials ◽  
Early Phase ◽  
Event Times ◽  
Early Phase Clinical Trials

scholarly journals Bayesian adaptive design of early-phase clinical trials for precision medicine based on cancer biomarkers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shinjo Yada
Keyword(s):  
Neural Network ◽  
Clinical Trials ◽  
Precision Medicine ◽  
Early Phase ◽  
Patient Specific ◽  
Specific Gene ◽  
Cancer Type ◽  
Background Characteristics ◽  
Number Of Patients ◽  
Early Phase Clinical Trials

Abstract Cancer tissue samples obtained via biopsy or surgery were examined for specific gene mutations by genetic testing to inform treatment. Precision medicine, which considers not only the cancer type and location, but also the genetic information, environment, and lifestyle of each patient, can be applied for disease prevention and treatment in individual patients. The number of patient-specific characteristics, including biomarkers, has been increasing with time; these characteristics are highly correlated with outcomes. The number of patients at the beginning of early-phase clinical trials is often limited. Moreover, it is challenging to estimate parameters of models that include baseline characteristics as covariates such as biomarkers. To overcome these issues and promote personalized medicine, we propose a dose-finding method that considers patient background characteristics, including biomarkers, using a model for phase I/II oncology trials. We built a Bayesian neural network with input variables of dose, biomarkers, and interactions between dose and biomarkers and output variables of efficacy outcomes for each patient. We trained the neural network to select the optimal dose based on all background characteristics of a patient. Simulation analysis showed that the probability of selecting the desirable dose was higher using the proposed method than that using the naïve method.

scholarly journals Simian adenovirus vector production for early-phase clinical trials: A simple method applicable to multiple serotypes and using entirely disposable product-contact components

Vaccine ◽  
2019 ◽  
Vol 37 (47) ◽  
pp. 6951-6961 ◽  
Author(s):  
Sofiya Fedosyuk ◽  
Thomas Merritt ◽  
Marco Polo Peralta-Alvarez ◽  
Susan J Morris ◽  
Ada Lam ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Early Phase ◽  
Adenovirus Vector ◽  
Simple Method ◽  
Simian Adenovirus ◽  
Early Phase Clinical Trials

scholarly journals Targeting for Success: Demonstrating Proof-of-Concept with Mechanistic Early Phase Clinical Pharmacology Studies for Disease-Modification in Neurodegenerative Disorders

2021 ◽  
Vol 22 (4) ◽  
pp. 1615
Author(s):  
Maurits F. J. M. Vissers ◽  
Jules A. A. C. Heuberger ◽  
Geert Jan Groeneveld
Keyword(s):  
Clinical Trials ◽  
Failure Rate ◽  
Neurodegenerative Disorders ◽  
Early Phase ◽  
Proof Of Concept ◽  
Mesh Terms ◽  
Disease Modifying ◽  
Early Phase Clinical Trials ◽  
Pharmacodynamic Biomarkers ◽  
Response Biomarkers

The clinical failure rate for disease-modifying treatments (DMTs) that slow or stop disease progression has been nearly 100% for the major neurodegenerative disorders (NDDs), with many compounds failing in expensive and time-consuming phase 2 and 3 trials for lack of efficacy. Here, we critically review the use of pharmacological and mechanistic biomarkers in early phase clinical trials of DMTs in NDDs, and propose a roadmap for providing early proof-of-concept to increase R&D productivity in this field of high unmet medical need. A literature search was performed on published early phase clinical trials aimed at the evaluation of NDD DMT compounds using MESH terms in PubMed. Publications were selected that reported an early phase clinical trial with NDD DMT compounds between 2010 and November 2020. Attention was given to the reported use of pharmacodynamic (mechanistic and physiological response) biomarkers. A total of 121 early phase clinical trials were identified, of which 89 trials (74%) incorporated one or multiple pharmacodynamic biomarkers. However, only 65 trials (54%) used mechanistic (target occupancy or activation) biomarkers to demonstrate target engagement in humans. The most important categories of early phase mechanistic and response biomarkers are discussed and a roadmap for incorporation of a robust biomarker strategy for early phase NDD DMT clinical trials is proposed. As our understanding of NDDs is improving, there is a rise in potentially disease-modifying treatments being brought to the clinic. Further increasing the rational use of mechanistic biomarkers in early phase trials for these (targeted) therapies can increase R&D productivity with a quick win/fast fail approach in an area that has seen a nearly 100% failure rate to date.

Unified exact design with early stopping rules for single arm clinical trials with multiple endpoints

2021 ◽  
pp. 096228022110130
Author(s):  
Wei Wei ◽  
Denise Esserman ◽  
Michael Kane ◽  
Daniel Zelterman
Keyword(s):  
Clinical Trials ◽  
Early Phase ◽  
Decision Rules ◽  
Stopping Rules ◽  
Multiple Endpoints ◽  
Shiny App ◽  
R Shiny ◽  
Early Phase Clinical Trials ◽  
User Friendly ◽  
Exact Design

Adaptive designs are gaining popularity in early phase clinical trials because they enable investigators to change the course of a study in response to accumulating data. We propose a novel design to simultaneously monitor several endpoints. These include efficacy, futility, toxicity and other outcomes in early phase, single-arm studies. We construct a recursive relationship to compute the exact probabilities of stopping for any combination of endpoints without the need for simulation, given pre-specified decision rules. The proposed design is flexible in the number and timing of interim analyses. A R Shiny app with user-friendly web interface has been created to facilitate the implementation of the proposed design.

scholarly journals Discovery and Evaluation of Protein Biomarkers as a Signature of Wellness in Late-Stage Cancer Patients in Early Phase Clinical Trials

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2443
Author(s):  
Bethany Geary ◽  
Erin Peat ◽  
Sarah Dransfield ◽  
Natalie Cook ◽  
Fiona Thistlethwaite ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Early Phase ◽  
Characteristic Curve ◽  
Performance Status ◽  
Area Under The Curve ◽  
Protein Biomarkers ◽  
Late Stage Cancer ◽  
Early Phase Clinical Trials

TARGET (tumour characterisation to guide experimental targeted therapy) is a cancer precision medicine programme focused on molecular characterisation of patients entering early phase clinical trials. Performance status (PS) measures a patient’s ability to perform a variety of activities. However, the quality of present algorithms to assess PS is limited and based on qualitative clinician assessment. Plasma samples from patients enrolled into TARGET were analysed using the mass spectrometry (MS) technique: sequential window acquisition of all theoretical fragment ion spectra (SWATH)-MS. SWATH-MS was used on a discovery cohort of 55 patients to differentiate patients into either a good or poor prognosis by creation of a Wellness Score (WS) that showed stronger prediction of overall survival (p = 0.000551) compared to PS (p = 0.001). WS was then tested against a validation cohort of 77 patients showing significant (p = 0.000451) prediction of overall survival. WS in both sets had receiver operating characteristic curve area under the curve (AUC) values of 0.76 (p = 0.002) and 0.67 (p = 0.011): AUC of PS was 0.70 (p = 0.117) and 0.55 (p = 0.548). These signatures can now be evaluated further in larger patient populations to assess their utility in a clinical setting.

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