Cargando…

Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review

Failure in cancer drug development exacts heavy burdens on patients and research systems. To investigate inefficiencies and burdens in targeted drug development in cancer, we conducted a systematic review of all prelicensure trials for the anticancer drug, sorafenib (Bayer/Onyx Pharmaceuticals). We...

Descripción completa

Detalles Bibliográficos
Autores principales: Mattina, James, Carlisle, Benjamin, Hachem, Yasmina, Fergusson, Dean, Kimmelman, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291369/
https://www.ncbi.nlm.nih.gov/pubmed/28158308
http://dx.doi.org/10.1371/journal.pbio.2000487
_version_ 1782504765234610176
author Mattina, James
Carlisle, Benjamin
Hachem, Yasmina
Fergusson, Dean
Kimmelman, Jonathan
author_facet Mattina, James
Carlisle, Benjamin
Hachem, Yasmina
Fergusson, Dean
Kimmelman, Jonathan
author_sort Mattina, James
collection PubMed
description Failure in cancer drug development exacts heavy burdens on patients and research systems. To investigate inefficiencies and burdens in targeted drug development in cancer, we conducted a systematic review of all prelicensure trials for the anticancer drug, sorafenib (Bayer/Onyx Pharmaceuticals). We searched Embase and MEDLINE databases on October 14, 2014, for prelicensure clinical trials testing sorafenib against cancers. We measured risk by serious adverse event rates, benefit by objective response rates and survival, and trial success by prespecified primary endpoint attainment with acceptable toxicity. The first two clinically useful applications of sorafenib were discovered in the first 2 efficacy trials, after five drug-related deaths (4.6% of 108 total) and 93 total patient-years of involvement (2.4% of 3,928 total). Thereafter, sorafenib was tested in 26 indications and 67 drug combinations, leading to one additional licensure. Drug developers tested 5 indications in over 5 trials each, comprising 56 drug-related deaths (51.8% of 108 total) and 1,155 patient-years (29.4% of 3,928 total) of burden in unsuccessful attempts to discover utility against these malignancies. Overall, 32 Phase II trials (26% of Phase II activity) were duplicative, lacked appropriate follow-up, or were uninformative because of accrual failure, constituting 1,773 patients (15.6% of 11,355 total) participating in prelicensure sorafenib trials. The clinical utility of sorafenib was established early in development, with low burden on patients and resources. However, these early successes were followed by rapid and exhaustive testing against various malignancies and combination regimens, leading to excess patient burden. Our evaluation of sorafenib development suggests many opportunities for reducing costs and unnecessary patient burden in cancer drug development.
format Online
Article
Text
id pubmed-5291369
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-52913692017-02-17 Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review Mattina, James Carlisle, Benjamin Hachem, Yasmina Fergusson, Dean Kimmelman, Jonathan PLoS Biol Meta-Research Article Failure in cancer drug development exacts heavy burdens on patients and research systems. To investigate inefficiencies and burdens in targeted drug development in cancer, we conducted a systematic review of all prelicensure trials for the anticancer drug, sorafenib (Bayer/Onyx Pharmaceuticals). We searched Embase and MEDLINE databases on October 14, 2014, for prelicensure clinical trials testing sorafenib against cancers. We measured risk by serious adverse event rates, benefit by objective response rates and survival, and trial success by prespecified primary endpoint attainment with acceptable toxicity. The first two clinically useful applications of sorafenib were discovered in the first 2 efficacy trials, after five drug-related deaths (4.6% of 108 total) and 93 total patient-years of involvement (2.4% of 3,928 total). Thereafter, sorafenib was tested in 26 indications and 67 drug combinations, leading to one additional licensure. Drug developers tested 5 indications in over 5 trials each, comprising 56 drug-related deaths (51.8% of 108 total) and 1,155 patient-years (29.4% of 3,928 total) of burden in unsuccessful attempts to discover utility against these malignancies. Overall, 32 Phase II trials (26% of Phase II activity) were duplicative, lacked appropriate follow-up, or were uninformative because of accrual failure, constituting 1,773 patients (15.6% of 11,355 total) participating in prelicensure sorafenib trials. The clinical utility of sorafenib was established early in development, with low burden on patients and resources. However, these early successes were followed by rapid and exhaustive testing against various malignancies and combination regimens, leading to excess patient burden. Our evaluation of sorafenib development suggests many opportunities for reducing costs and unnecessary patient burden in cancer drug development. Public Library of Science 2017-02-03 /pmc/articles/PMC5291369/ /pubmed/28158308 http://dx.doi.org/10.1371/journal.pbio.2000487 Text en © 2017 Mattina et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Meta-Research Article
Mattina, James
Carlisle, Benjamin
Hachem, Yasmina
Fergusson, Dean
Kimmelman, Jonathan
Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review
title Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review
title_full Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review
title_fullStr Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review
title_full_unstemmed Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review
title_short Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review
title_sort inefficiencies and patient burdens in the development of the targeted cancer drug sorafenib: a systematic review
topic Meta-Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291369/
https://www.ncbi.nlm.nih.gov/pubmed/28158308
http://dx.doi.org/10.1371/journal.pbio.2000487
work_keys_str_mv AT mattinajames inefficienciesandpatientburdensinthedevelopmentofthetargetedcancerdrugsorafenibasystematicreview
AT carlislebenjamin inefficienciesandpatientburdensinthedevelopmentofthetargetedcancerdrugsorafenibasystematicreview
AT hachemyasmina inefficienciesandpatientburdensinthedevelopmentofthetargetedcancerdrugsorafenibasystematicreview
AT fergussondean inefficienciesandpatientburdensinthedevelopmentofthetargetedcancerdrugsorafenibasystematicreview
AT kimmelmanjonathan inefficienciesandpatientburdensinthedevelopmentofthetargetedcancerdrugsorafenibasystematicreview