1. Accelerated Approvals in Oncology
Richard Pazdur, MD
Director, Oncology Drug Products

2. Oncology Accelerated Approvals
Confirmatory trials: an integral part of a comprehensive drug development strategy
Patient population in AA versus population in the confirmatory trials
Merits of different trial designs
Single-arm versus randomized trials

3. Timing of Confirmatory Trials
“Post-marketing studies would usually be underway”
Comprehensive drug development program
Confirmatory trials integrated in the development program

4. Timing of Confirmatory Trials
Accelerated approval may impact accrual to confirmatory trials
Early design and integration allows further questions to be formulated and answered in confirmatory trials

5. Timing of Confirmatory Trials
Discussions prior to initiation and during the trial
to ensure adequate accrual
to discuss alternative design
Special protocol assessments
Clear understanding of “due diligence” with periodic review of timeline

6. Study Population Refractory setting: unique mechanism?
Confirmatory trials in a less refractory population than initial accelerated approval
Moves the drug to first-line and adjuvant trials
Assists in accrual after accelerated approval
Clinical benefit in approved indication?

7. Refractory Patient Population
May miss potentially active drug
Progressively more refractory indications
Difficulty in characterizing toxic effects

8. Trial Designs Single-arm trials--faster trial completion
Randomized trials allow
Additional endpoints
Completion of clinical benefit in same study
Comparative toxicity

9. Trial Designs--Randomized trials
Novel cytostatic agents
“Add on” trials
Limitations
Time
Expense

10. Accelerated Approval: HIV Trials
Two large randomized trials for AA
HIV-RNA at 24 weeks (surrogate)
HIV-RNA in same population, same study at 48 weeks (confirmatory evidence of clinical benefit)
Implications for oncology trial designs

11. Goals Constructive dialogue--designing, completing confirmatory trials
Proactive in assessing study design, endpoints, accrual problems, due diligence
Confirmatory trials: an integral part of an AA plan
Recurring public meetings