Exley Andrew R, Rantell Khadija, McBlane James
Biologicals and Biotechnology Unit, Licensing Division, Medicines and HealthCare Products Regulatory Agency, 10 South Colonnade, Canary Wharf, London E14 4PU, UK.
Statistics and Pharmacokinetics Unit, Licensing Division, Medicines and HealthCare Products Regulatory Agency, 10 South Colonnade, Canary Wharf, London E14 4PU, UK.
Eur J Cancer. 2020 Oct;138:41-53. doi: 10.1016/j.ejca.2020.07.006. Epub 2020 Aug 21.
Novel cell therapies for haematological malignancies and solid tumours address pressing clinical need while offering potentially paradigm shifts in efficacy. However, innovative development risks outflanking information on statutory frameworks, regulatory guidelines and their working application. Meeting this challenge, regulators offer wide-ranging expertise and experience in confidential scientific and regulatory advice. We advocate early incorporation of regulatory perspectives to support strategic development of clinical programmes. We examine critical issues and key advances in clinical oncology trials to highlight practical approaches to optimising the clinical development of cell therapies. We recommend early consideration of collaborative networks, early-access schemes, reducing bias in single-arm trials, adaptive trials, clinical end-points supporting risk/benefit and cost/benefit analyses, companion diagnostics, real-world data and common technical issues. This symbiotic approach between developers and regulators should reduce development risk, safely expedite marketing authorisation, and promote early, wider availability of potentially transformative cell therapies for cancer.
用于血液系统恶性肿瘤和实体瘤的新型细胞疗法满足了紧迫的临床需求,同时在疗效方面可能带来范式转变。然而,创新发展可能会超越关于法定框架、监管指南及其实际应用的信息。为应对这一挑战,监管机构在保密的科学和监管建议方面提供广泛的专业知识和经验。我们主张尽早纳入监管视角,以支持临床项目的战略发展。我们审视临床肿瘤学试验中的关键问题和重要进展,以突出优化细胞疗法临床开发的实用方法。我们建议尽早考虑合作网络、早期获取计划、减少单臂试验中的偏差、适应性试验、支持风险/收益和成本/收益分析的临床终点、伴随诊断、真实世界数据以及常见技术问题。开发者和监管机构之间的这种共生方法应降低开发风险,安全加快上市许可,并促进潜在变革性癌症细胞疗法的早期、更广泛应用。