Generic placeholder image

Current Cancer Therapy Reviews

Editor-in-Chief

ISSN (Print): 1573-3947
ISSN (Online): 1875-6301

Cross-Sectional Study

Understanding the Challenges Associated with Approval of Anticancer Products to Facilitate the Regulatory Approvals: A Cross-sectional Study

Author(s): Pinky Sharma, Vikas Jhawat*, Jatinder Singh and Rohit Dutt

Volume 20, Issue 6, 2024

Published on: 08 January, 2024

Page: [601 - 608] Pages: 8

DOI: 10.2174/0115733947273426231128054645

Price: $65

Abstract

Purpose: Oncological medications face a myriad of challenges, including technological, pre-clinical, clinical, and manufacturing, that lead to regulatory approval delays or failures. The present study aims to identify some challenges encountered by researchers or regulators during the development of novel cancer therapies.

Methods: The present cross-sectional observational study used a mixed-method design methodology. The participants were selected via a non-random sampling method via self-selection and snowballing approach. A survey questionnaire was developed and circulated among the selected participants as a hard copy or email or a Google form. Open-ended and closed-ended questions were incorporated to identify the regulatory challenges faced during oncology drug development. The responses were collected from September 2021 to June 2022. These responses were then coded and themes were identified for the challenges.

Results: A total of 87 responses were obtained for the questionnaire among the individuals contacted. Seven themes were identified from the collated responses that depicted the challenges for the regulatory approval of anticancer drug products. The majority of responders (38.2%) suggested reduced approval time whereas endpoint selection and study design were considered as a challenge by 12.0% of responders each. Furthermore, 6.0% of responders admit that timely interaction with the regulators is also a challenge that delays approval. Many challenges also exist during the product development phase; hence, 12.0% of responders reported safety issues, and 22.0% of responders reported technical issues during manufacturing as the cause of regulatory failure. Moreover, 12.0% of responders suggested the need for improvements in regulatory guidelines for oncology drug development.

Conclusion: The survey indicates a lack of Indian guidelines for anticancer products, whereas limited guidance is available from other countries such as Europe or the United States. Thus, the survey points to the necessity for improvement in the regulatory guidelines and drug approval process to address the challenges unique to cancer drug development.

Graphical Abstract

[2]
Estimated number of new cases from 2020 to 2040, Both sexes, age [0-85+]. 2020. Available from: https://gco.iarc.fr/tomorrow/en/dataviz/isotype?populations=356&group_populations=1&multiple_populations=1&single_unit=50000
[3]
Chakraborty S, Rahman T. The difficulties in cancer treatment. Ecancermedicalscience 2012; 6: ed16.
[PMID: 24883085]
[4]
Pucci C, Martinelli C, Ciofani G. Innovative approaches for cancer treatment: Current perspectives and new challenges. Ecancermedicalscience 2019; 13: 961.
[http://dx.doi.org/10.3332/ecancer.2019.961] [PMID: 31537986]
[5]
Robertson J, Barr R, Shulman LN, Forte GB, Magrini N. Essential medicines for cancer: WHO recommendations and national priorities. Bull World Health Organ 2016; 94(10): 735-42.
[http://dx.doi.org/10.2471/BLT.15.163998] [PMID: 27843163]
[6]
Gyawali B, Carson LM, Berry S, Moraes FY. Challenges of globalization of cancer drug trials-recruitment in LMICs, approval in HICs. Lancet Regional Health - Americas 2022; 7: 100157.
[http://dx.doi.org/10.1016/j.lana.2021.100157] [PMID: 36777649]
[7]
Kunnumakkara AB, Bordoloi D, Sailo BL, et al. Cancer drug development: The missing links. Exp Biol Med 2019; 244(8): 663-89.
[http://dx.doi.org/10.1177/1535370219839163] [PMID: 30961357]
[8]
Lorscheider M, Gaudin A, Nakhlé J, Veiman KL, Richard J, Chassaing C. Challenges and opportunities in the delivery of cancer therapeutics: Update on recent progress. Ther Deliv 2021; 12(1): 55-76.
[http://dx.doi.org/10.4155/tde-2020-0079] [PMID: 33307811]
[9]
Li BT, Daly B, Gospodarowicz M, et al. Reimagining patient-centric cancer clinical trials: A multi-stakeholder international coalition. Nat Med 2022; 28(4): 620-6.
[http://dx.doi.org/10.1038/s41591-022-01775-6] [PMID: 35440725]
[10]
Senderowicz AM, Pfaff O. Similarities and differences in the oncology drug approval process between FDA and European Union with emphasis on in vitro companion diagnostics. Clin Cancer Res 2014; 20(6): 1445-52.
[http://dx.doi.org/10.1158/1078-0432.CCR-13-1761] [PMID: 24634467]
[11]
Implementing a national cancer clinical trials system for the 21st century: Second workshop summary. Washington (DC): National Academies Press (US) 2013.
[12]
Schoonenboom J, Johnson RB. How to construct a mixed methods research design. Kolner Z Soz Sozialpsychol (Aufl) 2017; 69(S2): 107-31.
[http://dx.doi.org/10.1007/s11577-017-0454-1] [PMID: 28989188]
[13]
Creswell JW, Clark VLP. Choosing a mixed method design. In: Clark P, Ed. Designing and conducting mixed methods research. (2nd ed.). SAGE Publications 2011; pp. 58-88.
[14]
Kelley K, Clark B, Brown V, Sitzia J. Good practice in the conduct and reporting of survey research. Int J Qual Health Care 2003; 15(3): 261-6.
[http://dx.doi.org/10.1093/intqhc/mzg031] [PMID: 12803354]
[15]
Saunders M, Lewis P, Thornhill A. Selecting samples. In: Saunders M, Lewis P, Thornhill A, Eds Research methods for business students. 8th ed. Harlow, United Kingdom: Pearson 2019; pp. 292-334.
[16]
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
[http://dx.doi.org/10.1191/1478088706qp063oa]
[17]
Clarke V, Braun V. Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning. Psychologist 2013; 26: 120-3.
[18]
Samuel N, Verma S. Cross-comparison of cancer drug approvals at three international regulatory agencies. Curr Oncol 2016; 23(5): 454-60.
[http://dx.doi.org/10.3747/co.23.2803] [PMID: 27803605]
[19]
Xie J, Li J, Liu Y, et al. Comparison of novel oncology drugs that received dual approval from the US accelerated approval and EU conditional marketing authorisation pathways, 2006–2021: A cross-sectional study. BMJ Open 2023; 13(6): e069132.
[http://dx.doi.org/10.1136/bmjopen-2022-069132] [PMID: 37286329]
[20]
Ruff P, Al-Sukhun S, Blanchard C, Shulman LN. Access to cancer therapeutics in low- and middle-income countries. Am Soc Clin Oncol Educ Book 2016; 35: 58-65.
[21]
Lythgoe M, Krell J, Warner JL, Desai A, Khaki AR. Time intervals between U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) new cancer therapy approvals. J Clin Oncol 2021; 39(S15): 1575.
[http://dx.doi.org/10.1200/JCO.2021.39.15_suppl.1575]
[22]
Lythgoe MP, Desai A, Gyawali B, et al. Cancer therapy approval timings, review speed, and publication of pivotal registration trials in the us and europe, 2010-2019. JAMA Netw Open 2022; 5(6): e2216183.
[http://dx.doi.org/10.1001/jamanetworkopen.2022.16183] [PMID: 35687337]
[23]
Tibau A, Molto C, Ocana A, et al. Magnitude of clinical benefit of cancer drugs approved by the us food and drug administration. J Natl Cancer Inst 2018; 110(5): 486-92.
[http://dx.doi.org/10.1093/jnci/djx232] [PMID: 29244173]
[24]
Garsen M, Steenhof M, Zwiers A. A decade of marketing authorization applications of anticancer drugs in the european union: An analysis of procedural timelines. Ther Innov Regul Sci 2021; 55(4): 633-42.
[http://dx.doi.org/10.1007/s43441-021-00260-5] [PMID: 33543409]
[25]
Chisholm O, Critchley H. Future directions in regulatory affairs. Front Med 2023; 9: 1082384.
[http://dx.doi.org/10.3389/fmed.2022.1082384] [PMID: 36698838]
[27]
Lyerly HK, Ren J, Canetta R, et al. Global development of anticancer therapies for rare cancers, pediatric cancers, and molecular subtypes of common cancers. J Glob Oncol 2018; 4(4): 1-11.
[http://dx.doi.org/10.1200/JGO.18.00092] [PMID: 30521412]
[28]
Hartmann M, Mayer-Nicolai C, Pfaff O. Approval probabilities and regulatory review patterns for anticancer drugs in the European Union. Crit Rev Oncol Hematol 2013; 87(2): 112-21.
[http://dx.doi.org/10.1016/j.critrevonc.2013.01.004] [PMID: 23433721]
[29]
Delgado A, Guddati AK. Clinical endpoints in oncology - a primer. Am J Cancer Res 2021; 11(4): 1121-31.
[PMID: 33948349]
[30]
Kemp R, Prasad V. Surrogate endpoints in oncology: when are they acceptable for regulatory and clinical decisions, and are they currently overused? BMC Med 2017; 15(1): 134.
[http://dx.doi.org/10.1186/s12916-017-0902-9] [PMID: 28728605]
[31]
Kim C, Prasad V. Strength of validation for surrogate end points used in the US food and drug administration’s approval of oncology drugs. Mayo Clin Proc 2016.
[http://dx.doi.org/10.1016/j.mayocp.2016.02.012]
[32]
Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: Retrospective cohort study of drug approvals 2009-13. BMJ 2017; 359: j4530.
[http://dx.doi.org/10.1136/bmj.j4530] [PMID: 28978555]
[33]
Pasalic D, McGinnis GJ, Fuller CD, et al. Progression-free survival is a suboptimal predictor for overall survival among metastatic solid tumour clinical trials. Eur J Cancer 2020; 136: 176-85.
[http://dx.doi.org/10.1016/j.ejca.2020.06.015] [PMID: 32702645]
[34]
[35]
Falcone R, Lombardi P, Filetti M, et al. Oncologic drugs approval in europe for solid tumors: Overview of the last 6 years. Cancers 2022; 14(4): 889.
[http://dx.doi.org/10.3390/cancers14040889] [PMID: 35205637]
[36]
Demonstrating Substantial Evidence of Effectiveness for Human Drug and Biological Products. 2019. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/demonstrating-substantial-evidence-effectiveness-human-drug-and-biological-products
[37]
Hariton E, Locascio JJ. Randomised controlled trials – the gold standard for effectiveness research. BJOG 2018; 125(13): 1716.
[http://dx.doi.org/10.1111/1471-0528.15199] [PMID: 29916205]
[38]
Clinical trial endpoints for the approval of cancer drugs and biologics 2020. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/clinical-trial-endpoints-approval-cancer-drugs-and-biologics
[39]
Guideline on the evaluation of anticancer medicinal products in man. 2017. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-evaluation-anticancer-medicinal-products-man-revision-5_en.pdf
[40]
Apolone G, Joppi R, Bertele’ V, Garattini S. Ten years of marketing approvals of anticancer drugs in Europe: regulatory policy and guidance documents need to find a balance between different pressures. Br J Cancer 2005; 93(5): 504-9.
[http://dx.doi.org/10.1038/sj.bjc.6602750] [PMID: 16136026]
[41]
Agrawal S, Arora S, Vallejo JJ, Gwise T, Chuk MK, Amiri-Kordestani L. Use of single-arm trials to support malignant hematology and oncology drug and biologic approvals: A 20-year fda experience. J Clin Oncol 2021; 39(S15): e13572.
[42]
Vancoppenolle JM, Koole SN, O’Mahony JF, et al. Targeted combination therapies in oncology: Challenging regulatory frameworks designed for monotherapies in Europe. Drug Discov Today 2023; 28(8): 103620.
[http://dx.doi.org/10.1016/j.drudis.2023.103620] [PMID: 37201780]
[43]
Farrell AT, Papadouli I, Hori A, et al. The advisory process for anticancer drug regulation: A global perspective. Ann Oncol 2006; 17(6): 889-96.
[http://dx.doi.org/10.1093/annonc/mdj099] [PMID: 16357020]
[44]
Franco P, Jain R, Rosenkrands-Lange E, Hey C, Koban MU. Regulatory pathways supporting expedited drug development and approval in ich member countries. Ther Innov Regul Sci 2023; 57(3): 484-514.
[http://dx.doi.org/10.1007/s43441-022-00480-3] [PMID: 36463352]
[45]
Fujikawa M, Ono S. Analysis of safety-related regulatory actions for new drugs in japan by nature of identified risks. Pharmaceut Med 2017; 31(5): 317-27.
[http://dx.doi.org/10.1007/s40290-017-0198-2] [PMID: 29056852]
[46]
Nakayama H, Matsumaru N, Tsukamoto K. Safety-related regulatory actions and risk factors for anticancer drugs in japan. Pharmaceut Med 2019; 33(1): 45-52.
[http://dx.doi.org/10.1007/s40290-018-0260-8] [PMID: 31933266]
[47]
Kim J, Nair A, Keegan P, et al. Evaluation of serious postmarket safety signals within 2 years of fda approval for new cancer drugs. Oncologist 2020; 25(4): 348-54.
[http://dx.doi.org/10.1634/theoncologist.2019-0653] [PMID: 32297444]
[48]
Hegde PS, Chen DS. Top 10 challenges in cancer immunotherapy. Immunity 2020; 52(1): 17-35.
[http://dx.doi.org/10.1016/j.immuni.2019.12.011] [PMID: 31940268]
[49]
Feinberg BA, Gajra A, Zettler ME, Phillips TD, Phillips EG Jr, Kish JK. Use of real-world evidence to support fda approval of oncology drugs. Value Health 2020; 23(10): 1358-65.
[http://dx.doi.org/10.1016/j.jval.2020.06.006] [PMID: 33032780]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy