title: Accelerated approval of oncology products: the food and drug administration experience.
abstract: We reviewed the regulatory history of the accelerated approval process and the US Food and Drug Administration (FDA) experience with accelerated approval of oncology products from its initiation in December 11, 1992, to July 1, 2010. The accelerated approval regulations allowed accelerated approval of products to treat serious or life-threatening diseases based on surrogate endpoints that are reasonably likely to predict clinical benefit. Failure to complete postapproval trials to confirm clinical benefit with due diligence could result in removal of the accelerated approval indication from the market. From December 11, 1992, to July 1, 2010, the FDA granted accelerated approval to 35 oncology products for 47 new indications. Clinical benefit was confirmed in postapproval trials for 26 of the 47 new indications, resulting in conversion to regular approval. The median time between accelerated approval and regular approval of oncology products was 3.9 years (range = 0.8-12.6 years) and the mean time was 4.7 years, representing a substantial time savings in terms of earlier availability of drugs to cancer patients. Three new indications did not show clinical benefit when confirmatory postapproval trials were completed and were subsequently removed from the market or had restricted distribution plans implemented. Confirmatory trials were not completed for 14 new indications. The five longest intervals from receipt of accelerated approval to July 1, 2010, without completion of trials to confirm clinical benefit were 10.5, 6.4, 5.5, 5.5, and 4.7 years. The five longest intervals between accelerated approval and successful conversion to regular approval were 12.6, 9.7, 8.1, 7.5, and 7.4 years. Trials to confirm clinical benefit should be part of the drug development plan and should be in progress at the time of an application seeking accelerated approval to prevent an ineffective drug from remaining on the market for an unacceptable time.
authors.affiliation: Division of Drug Oncology Products, Office of Oncology Drug Products, 10903 New Hampshire Ave, Bldg 22, Rm 2117, Silver Spring, MD 20993, USA. johnsonj@cder.fda.gov
authors.forename: John R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Yang-Min
authors.initials: YM
authors.lastname: Ning
authors.forename: Ann
authors.initials: A
authors.lastname: Farrell
authors.forename: Robert
authors.initials: R
authors.lastname: Justice
authors.forename: Patricia
authors.initials: P
authors.lastname: Keegan
authors.forename: Richard
authors.initials: R
authors.lastname: Pazdur
mesh_terms: D000970:Antineoplastic Agents; D002986:Clinical Trials as Topic; D017327:Clinical Trials, Phase IV as Topic; D018572:Disease-Free Survival; D017277:Drug Approval / Q000331:legislation & jurisprudence* / Q000379:methods*; D004345:Drug Industry / Q000191:economics; D006801:Humans; D007880:Legislation, Drug / Q000592:standards / Q000639:trends; D011358:Product Surveillance, Postmarketing; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D035501:Uncertainty; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000970:Antineoplastic Agents