Cancer Drugs: Better, Cheaper

UCSF-Led National Breast Cancer Research Helps Pave New Regulatory Path

By UCSF News | June 1, 2012

Cancer Drugs: Better, Cheaper

Laura Esserman, MD, MBA

Cancer drug development is known to be too slow, costly and fraught with failure. Now the U.S. Food and Drug Administration is issuing recommendations for breast cancer trials that would substantially accelerate patient access to new medications while lowering the time and cost of drug development. The new regulatory guidelines are based in part on groundbreaking, national breast cancer research led by UCSF.

The FDA “draft guidance,’’ issued last week, is aimed at helping medical researchers gain swifter approval for promising drugs in the early stages of development for breast cancer. The guidance represents the federal agency’s “current thinking on this topic,’’ according to the draft.
The guidelines are discussed in the current issue of The New England Journal of Medicine.

The FDA’s new approach is based on a trial design being tested in a clinical study known as I-SPY 2, launched by UCSF in conjunction with a private-public partnership that includes the FDA, the National Institutes of Health, pharmaceutical companies and academic medical centers.

I-SPY 2 combines personalized medicine with a novel investigational design to identify women at high risk of early breast cancer recurrence. It is underway at 19 major cancer research centers around the country.

“Better options for patients with high-risk breast cancer are urgently needed,’’ said Janet Woodcock, MD, director of the Center for Drug Evaluation and Research at the FDA. “The FDA guidance explains how a promising drug identified in trials such as I-SPY 2 could be evaluated for FDA approval, so patients could have rapid access if the drug proved better than current treatments.’’

Traditionally, patients with early-stage breast cancer must wait years to receive new cancer drugs, which are generally tested first in patients with later stage metastatic disease and approved for use in more curable, early stage cancer only after additional clinical trials.

It can take more than a decade to bring a new cancer drug to the market and cost more than $1 billion.

The need for new regulatory approaches was discussed in a December 2011 commentary in the Journal of the American Medical Association (JAMA) co-authored by Woodcock and Laura Esserman, MD, MBA, director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center.

“The major losers in this inefficient approach are the patients who would benefit from new treatments,’’ wrote Esserman and Woodcock in their JAMA article.

But combining novel trial designs with new approaches for accelerated approval would hasten the pace through the research pipeline to bring medications to patients at far lower costs, the authors wrote.

Read more at UCSF News