From our perspective: Expedited oncology drug approvals
Richard Pazdur, M.D., Director of the Office of Hematology and Oncology Products, highlights some of his office’s 2015 approvals and discusses a few of the expedited review programs that are used by the office.
Oncology drug approvals: year in review
This past year, we have made great strides in the treatment of multiple myeloma, approving Darzalex (daratumumab), Empliciti (elotuzumab), Ninlaro (ixazomib), and Farydak (panobinostat) to treat this disease. Other noteworthy achievements include the approval of the first biosimilar product in the United States, Zarxio (filgrastim-sndz) a bone marrow stimulant that helps the body make white blood cells after receiving cancer medications, and Unituxin (dinutuximab), which is part of a first-line therapy for pediatric patients with high-risk neuroblastoma.
November 2015 was a particularly busy month with the approval of six new oncology drugs, the majority of which were approved using expedited review programs.
Expedited programs and review at OHOP
FDA reviews new drug applications according to timeframes established by the Prescription Drug User Fee Act (PDUFA). There are also programs in place to expedite the drug development and review timeline, and many of the innovative therapies that were approved by OHOP this past year received an expedited designation. Generally, these designations are given to therapies that we consider to be better than what is currently on the market or that fulfill an unmet medical need. The accelerated approval, priority review, and breakthrough therapy programs are frequently used with new oncology drugs, and often a single drug receives multiple designations.
OHOP frequently uses the accelerated approval pathway which allows us to approve the drug based upon a surrogate endpoint or marker that is reasonably likely to predict a clinical benefit, like an improvement in overall survival. Following an accelerated approval, companies conduct additional confirmatory clinical trials with the drug to further examine its clinical benefit. The use of surrogate endpoints and confirmatory trials shifts the lengthy analysis of survival to the post-market setting and provides patients with earlier access to promising new drugs.
Another program used by OHOP to expedite the approval of a drug is the priority review designation. This program is focused on drugs that treat serious and life-threatening diseases and, if approved, would provide a significant improvement in safety or effectiveness over available therapy. Applications receiving a priority review have a shorter timeframe for review of the marketing application.
The newest program aimed at expediting the development of drugs for serious and life-threatening diseases is the breakthrough therapy designation. This program is designed for drugs where preliminary evidence indicates that the drug may demonstrate a substantial improvement on a clinically significant endpoint over available therapy. When a drug is granted breakthrough therapy designation, review offices such as OHOP help expedite the development and review of the drug often by having a more dynamic interaction with pharmaceutical companies with the intent to resolve any problematic issues as early as possible.
Why oncology drugs receive expedited reviews
Expedited reviews or early actions are not a new phenomenon in oncology. One of the earliest expedited reviews for an oncologic drug was the approval of Gleevec (imatinib) in May 2001 for chronic myeloid leukemia. The review and approval of Gleevec occurred in approximately 2.5 months. In the last five years, approximately 60 percent of OHOP’s NME approvals were ahead of the PDUFA timeframe.
Over the years, oncology drugs have become “targeted agents” aimed at specific molecular pathways or targets that are involved in cancer growth. These drugs have been developed because of a greater basic scientific understanding of how cancers grow. Examples of targeted agents approved in 2015 include Alecensa (alectinib) and Tagrisso (osimertinib) for the treatment of specific types of lung cancer as well as the approval of Cotellic (cobimetinib) for the treatment of metastatic melanoma. Drugs aimed at a specific molecular target generally have greater effectiveness in a specific population and may generally have a more favorable benefit-risk profile.
Many other factors enable OHOP to expedite the approval of an oncology drug, especially if the drug has an improved benefit and reduced risks. Newer drugs are demonstrating high response rates that are substantially better than what is presently available. This is particularly evident in drugs that have received breakthrough therapy designations.
Safety and effectiveness of oncology drugs with expedited approvals
I must emphasize that an expedited review or an early approval does not mean that the drug is any less safe or effective than one that is approved closer to or on its PDUFA date. Many of OHOP’s oncologists are practicing physicians who assume the care of patients with cancer and understand the need to facilitate the approval of important drugs while maintaining the high standards of safety and effectiveness.
Early approvals are not at the expense of the quality of the review. Extra resources are allocated to the review of these applications by assigning multiple reviewers to an application, enhancing communication within the review teams and field inspectors, as well as providing greater communication with sponsors to quickly resolve issues that may arise during the review. This resource allocation planning often begins prior to the actual application being submitted to FDA.
Working with the cancer community
Our goal is to keep making safe, innovative, and effective cancer treatments available for patients. OHOP currently has several ongoing projects with advocacy groups and professional organizations to facilitate regulatory science aimed at getting safe and effective cancer therapies to patients faster.
We have held workshops with these groups to examine dosing of oncology drugs to optimize the effectiveness and reduce toxicity of cancer drugs, ways of improving and facilitating access to unapproved drugs, as well as efforts to increase enrollment in clinical trials by expanding the eligibility criteria for these trials.
We work closely with other centers and offices throughout the agency as well as the National Cancer Institute. OHOP also participates in a monthly teleconference with drug regulators from other countries to share ideas and concerns regarding various oncology drug applications.
OHOP also plans to expand on the agency’s “patient voice” initiative. Over the next year, OHOP will begin a project on patient-reported toxicity as a way to incorporate the patient’s perspective in the description of toxicity and the safety of cancer treatments.
Continuing to ensure safe and effective oncology drug products
In 2016, OHOP will continue to conduct thorough reviews of oncology drug product applications and approve drugs that meet the agency’s rigorous standards. We have over 70 medical oncologists as well as pediatric oncologists, radiation oncologists, oncology nurses, physician assistants, and oncology pharmacists who participate in the clinical evaluation of safety and effectiveness of oncology drugs. In addition, there are statisticians, basic scientists examining the clinical pharmacology and toxicology of these drugs, and chemists involved in the review of manufacturing. Through the use of the expedited review programs and the commitment of these individuals, our aim is to provide the American public facing serious and life-threatening diseases with the latest advancements in the field while ensuring the safety and effectiveness of these drugs.