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cancer treatment outcomes outcomes drug approval clinical data FDA

Clinical Trial Evidence Supporting US Food and Drug Administration Approval of Novel Cancer Therapies Between 2000 and 2016


Summary

  • Data from 17 years of studies on novel cancer drugs show limited information available at market entry.
  • Randomized Controlled Trials (RCTs) data are available for only half of the drug indications.
  • Lack of data is particularly problematic for patients with hematological cancers.
  • Novel therapies may reduce tumor size or other tumor response markers.
  • These therapies extend patient life by a median of only 73 days.
  • Novel drugs should be used cautiously without expecting significant survival extension.
  • Post-licensing clinical trials can provide more precise information on drug benefits.
  • Many drugs are approved to meet an unmet medical need, which still exists.

Cancer research is characterized by the perceived urgency to develop novel drugs that may improve patients’ survival and quality of life. Before patients have access to novel therapies, the available evidence on benefits and harms from clinical trials is assessed by authoritative institutions, such as the US Food and Drug Administration (FDA). Several regulatory programs have been established to expedite the development and approval of drugs for serious conditions, such as cancer. These programs may allow patients to have earlier access to beneficial drugs; however, there is concern that these programs may increase uncertainty in clinical decision-making, as approvals based on these regulations often rely on evidence from fewer and smaller studies, surrogate outcomes, and studies that are more likely to be biased owing to a lack of randomization and adequate controls.

Previous analyses have described the evidence used to support FDA approval of cancer therapies for periods before 2013, with a focus on certain types of cancer or on the use of certain end points in clinical trials aimed at drug approval. The objective of our study was to systematically investigate the available data on treatment outcomes for all cancer drugs approved by the FDA for the first time between 2000 and 2016. We described the regulatory characteristics and supporting clinical trials and calculated the treatment outcomes of overall survival (OS), progression-free survival (PFS), and tumor response.

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cancer treatment outcomes, outcomes, drug approval, clinical data, FDA