Use of genotoxicity data to support clinical trials or positive genetox findings on a candidate pharmaceutical or impurity .... now what?
Results from carcinogenicity studies are generally not available for drugs until the time of approval. Many people, including healthy volunteers are often exposed to pharmacologically active doses of the drug before carcinogenicity results are available. The Food and Drug Administration (FDA) Center for Drug Evaluation and Research uses results of genetic toxicology studies as a surrogate for carcinogenicity during the drug development phase (clinical trials). A number of issues are considered in deciding whether drugs that give positive results in genetic toxicology studies can be given to subjects in clinical trials. These relate to the drug indication, the target population, duration of treatment, and importance of the drug. In general, single-dose clinical studies are permitted regardless of the genetox results. In situations where a genetic toxicology assay showed a positive result, some review divisions have asked sponsors to perform a Syrian hamster embryo (SHE) cell transformation assay or a p53 carcinogenicity study prior to allowing repeat-dose clinical trials to proceed. This paper discusses alternatives to SHE cell and p53 assays when faced with a positive result in a genetic toxicology assay. In addition, this paper discusses factors to consider when setting limits for genotoxic impurities in drug substances and products.
Jacobson-Kram
David
D
Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, Maryland 20852, USA. jacobsonkram@cder.fda.gov
Jacobs
Abigail
A
D000818:Animals; D002986:Clinical Trials as Topic / Q000592:standards*; D017277:Drug Approval; D004340:Drug Contamination; D004353:Drug Evaluation, Preclinical; D015507:Drugs, Investigational / Q000633:toxicity*; D006801:Humans; D009152:Mutagenicity Tests; D018570:Risk Assessment
D015507:Drugs, Investigational