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The Future of Clinical Trials: New Model to Enhance Efficiency

The Future of Clinical Trials: New Model to Enhance Efficiency. Jeff Allen, PhD Executive Director Friends of Cancer Research. Current Challenges. Each potential new therapy is typically tested independently from other therapies seeking to treat the same condition

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The Future of Clinical Trials: New Model to Enhance Efficiency

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  1. The Future of Clinical Trials:New Model to Enhance Efficiency Jeff Allen, PhD Executive Director Friends of Cancer Research

  2. Current Challenges • Each potential new therapy is typically tested independently from other therapies seeking to treat the same condition • For every new trial, the protocol must be reviewed by a number of oversight entities • new phase III trials requires an average of 36 administrative or regulatory approvals and averages more than 2 years • Approximately 4% of adult cancer patients enroll in clinical trials • inability to meet accrual goals is a frequent factor causing trials to close, wasting time, money, and limited patient resources • New therapies molecularly targeted against specific mutations may be present in only a fraction of the patient population

  3. Design of a Disease-Specific Master Protocol 2012 Conference on Clinical Cancer Research http://www.focr.org/events/design-lung-cancer-master-protocol

  4. Major elements • Setting: Squamous cell carcinoma (SCCA), advanced stage, 2nd line therapy • Agents: Candidate drugs must demonstrate biologic activity against a measurable target with a proposed predictive biomarker • Study design: Multi-arm randomized, controlled phase II/III master registration protocol. Each arm able to open and close independent of other arms

  5. Screening • Archival FFPE tumor-common broad testing analytically validated platform suitable for registration purposes • Molecule–specific tests, to include IHC, fresh core needle biopsy as appropriate • Protocol arm powered for central test+ cases, with subsequent bridging studies as per FDA clearance. • Goal is to develop each molecule with a companion diagnostic to support clinical use

  6. Trial Structure • Primary Endpoint: Each arm independently powered for OS; interim analysis for PFS. Positive results at “rolling” interim analysis (no temporary closure) determine if a protocol arm proceeds to phase III portion. • Goal: minimum of 4 arms open at any time, to ascertain a reasonable chance for patients to be “biomarker positive”. • Marker-negative patients enter common control group treated with SoC (vs anti-PD1 agent) to establish annotated repository

  7. Trial operations • Operations Management: Neutral 3rdparty - FNIH in collaboration with NCI Cooperative Groups • Independent Drug Selection Committee: evaluates each drug-marker pair for suitability • Oversight Committee: Comprised of leaders from NCI, Academia, FDA, industry, advocates, to ensure operational efficacy

  8. MASTER PROTOCOL CNB/CLIA Biomarker Profiling CT* Unkn-Neg biomarker AntiPD1 Biomarker D Biomarker Β Biomarker A Biomarker C CT* CT* E* CT* TT B TT A TT C+CT TT D+E Endpoint (Interim PFS) OS Endpoint (Interim PFS) OS Endpoint (Interim PFS) OS Endpoint (Interim PFS) OS TT=Targeted therapy, CT=chemotherapy (docetaxel or gemcitabine), E=erlotinib Courtesy of: ValiPapadimitrakopoulou

  9. Study Design Within Each Biomarker-defined Subgroup Randomization Phase II Analysis 56 PFS events Phase III Interim Analyses Based on OS Final Analysis 210 OS events Complete Accrual Futility established 12 months follow-up Stop Courtesy of: Mary Redman

  10. Master Protocol over time Additional drug/biomarker combinations dropped and added to study

  11. Benefits of a Master Protocol • Enrollment Efficiency: Grouping these studies under a single trial reduces the overall screen failure rate • Operational Efficiency: single master protocol can be amended as needed as drugs enter and exit the study • Consistency: every drug entered into the trial would be tested in the identical manner • Predictability: If pre-specified efficacy and safety criteria are met, the drug and accompanying companion diagnostic will be approved • Patient Benefit: offers the advantage of bringing safe and effective drugs to patients sooner than they might otherwise be available.

  12. Expert Working Group • Roy Herbst – Yale University • David Gandara – UC Davis • ValiPapadimitrakopoulou – MD Anderson • Fred Hirsch – University of Colorado • Mary Redman - Fred Hutchinson Cancer Center • Jeff Abrams – National Cancer Institute • Jack Welch – National Cancer Institute • Shakun Malik – Food and Drug Administration • David Wholley – Foundation for the NIH • Vince Miller – Foundation Medicine • Eric Rubin - Merck

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