Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T07:58:49.244Z Has data issue: false hasContentIssue false

Ethics at Phase 0: Clarifying the Issues

Published online by Cambridge University Press:  01 January 2021

Extract

Many commentators have expressed concern that large investments in biomedical research over the past two decades have not been translated effectively into clinical applications. In its Critical Path Report, the Food and Drug Administration (FDA) characterized the problem as a “technological disconnect between discovery and the product development process,” and documented that the number of investigational new drugs (INDs) submitted to the agency had declined “significantly” since 2000. Along a similar vein, another study found that only five of 101 basic science studies showing significant therapeutic promise were successfully translated into clinical applications.

This perceived translational lag is stimulating a shift toward human testing of study interventions earlier in the drug development process. One indication of this trend is a recent guidance encouraging sponsors to pursue human “exploratory” studies before embarking on phase I trials.

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Food and Drug Administration, Critical Path Report, Innovation or Stagnation: Challenge and Opportunity on the Critical Path to New Medical Products, 2004.Google Scholar
Contopouluus-Ioannidis, D. G. Ntzani, E. Ioannidis, J. P., “Translation of Highly Promising Basic Science Research into Clinical Applications,” American Journal of Medicine 114, no. 6 (2003): 477–84.CrossRefGoogle Scholar
Food and Drug Administration, Centre for Drug Evaluation and Research (CDER), Guidance for Industry, Investigators and Reviewers: Exploratory IND Studies, 2006.Google Scholar
European Agency for the Evaluation of Medicinal Products, Position Paper on the Nonclinical Safety Studies to Support Clinical Trials with a Single Microdose, 2003.Google Scholar
National Cancer Institute, “NCI Supports Interagency Oncology Task Force Efforts to Stimulate Faster and Safer Development of New, Life-Saving Interventions for Cancer Patients,” January 2006, available at <http://www.cancer.gov/newscenter/pressreleases/FDAGuidance> (last visited August 2, 2007); Korieth, K., “Zeroing in on Microdosing,” CenterWatch 12, no. 2 (2005): 117.Google Scholar
Saleem, A., “Pharmacokinetic Evaluation of N-[2-(Dimethylamino) Ethyl] Acridine-4-Carboxamide in Patients by Positron Emission Tomography,” Journal of Clinical Oncology 19 (2001): 1421–29.CrossRefGoogle Scholar
See Korieth, , supra note 5.Google Scholar
See Saleem, , supra note 6; Lappin, G. et al. , “Use of Microdosing to Predict Pharmacokinetics at the Therapeutic Dose: Experience with 5 Drugs,” Clinical Pharmacology and Therapeutics 80, no. 3 (2006): 203–15.Google Scholar
A search on the Web site <Clinicaltrials.gov> turned up zero hits for various spellings of microdos* or micro-dos*; and only one protocol containing “phase 0” in its title, available at <http://clinicaltrials.gov> (last visited August 2, 2007).+turned+up+zero+hits+for+various+spellings+of+microdos*+or+micro-dos*;+and+only+one+protocol+containing+“phase+0”+in+its+title,+available+at++(last+visited+August+2,+2007).>Google Scholar
Twombly, R., “Slow Start to Phase 0 as Researchers Cebate Value,” Journal of the National Cancer Institute 98, no. 12 (2006): 804–6.CrossRefGoogle Scholar
See Korieth, , supra note 5.Google Scholar
Zabner, J. et al. , “Adenovirus-Mediated Gene Transfer Transiently Corrects the Chloride Transport Defect in Nasal Epithelia of Patients with Cystic Fibrosis,” Cell 75, no. 2 (1993): 207–16.CrossRefGoogle Scholar
Wadman, M., “Drive for Drugs Leads to Baby Clinical Trials,” Nature 440, no. 7083 (2006): 406–7.Google Scholar
Wood, A. J. Darbyshire, J., “Injury to Research Volunteers: The Clinical-Research Nightmare,” New England Journal of Medicine 354, no. 18 (2006): 1869–71.CrossRefGoogle Scholar
Newell, D. R. Silvester, J. McDowell, C. Burtles, S. S., “The Cancer Research U.K. Experience of Pre-Clinical Toxicology Studies to Support Early Clinical Trials with Novel Cancer Therapies,” European Journal of Cancer 40, no. 6 (2004): 899906.CrossRefGoogle Scholar
See Korieth, , supra note 5.Google Scholar
See Newell, , supra note 15; Newell, D. R. et al. , “Evaluation of Rodent-Only Toxicology for Early Clinical Trials with Novel Cancer Therapeutics,” British Journal of Cancer 81, no. 5 (1999): 760–8.CrossRefGoogle Scholar
Grieshaber, C. K. Marsoni, S., “Relation of Preclinical Toxicology to Findings in Early Clinical Trials,” Cancer Treatment Report 70, no. 1 (1986): 6572.Google Scholar
Tomaszewski, J. E., “Multi-Species Toxicology Approaches for Oncology Drugs: The U.S. Perspective,” European Journal of Cancer 40, no. 6 (2004): 907–13.CrossRefGoogle Scholar
Agulnik, M. Oza, A. M. Pond, G. R. Siu, L. L., “Impact of Perceptions of Mandatory Tumor Biopsies for Correlative Studies in Clinical Trials of Novel Anticancer Agents,” Journal of Clinical Oncology 24, no. 30 (2006): 4801–7.CrossRefGoogle Scholar
Daugherty, C. K. Banik, D. M. Janish, L. Ratain, M. J., “Quantitative Analysis of Ethical Issues in Phase I Trials: A Survey Interview Study of 144 Advanced Cancer Patients,” IRB 22, no. 3 (2000): 614; Daugherty, C. K. et al. , “Perceptions of Cancer Patients and Their Physicians Involved in Phase I Trials,” Journal Clinical Oncology 13, no. 5 (1995): 1062–72; Nurgat, Z. A. et al. , “Patient Motivations Surrounding Participation in Phase I and Phase II Clinical Trials of Cancer Chemotherapy,” British Journal of Cancer 92, no. 6 (2005): 1001–5; Henderson, G. E. et al. , “Therapeutic Misconception in Early Phase Gene Transfer Trials,” Social Sciences and Medicine 62, no. 1 (2006): 239–53; Hutchinson, C., “Phase I Trials in Cancer Patients: Participants' Perceptions,” European Journal of Cancer Care 7, no. 1 (1998): 15–22.CrossRefGoogle Scholar
Helft, P. R. Daugherty, C. K., “Are We Taking without Giving in Return? The Ethics of Research-Related Biopsies and the Benefits of Clinical Trial Participation,” Journal of Clinical Oncology 24, no. 30 (2006): 4793–5.CrossRefGoogle Scholar
Willis, R. C., “What Is Phase Zero?” Scientist 19, no. 20 (2005): 38.Google Scholar
Branca, M. A., “Academia Given a Helping Hand in Drug Development,” Nature Reviews Drug Discovery 5, no. 3 (2006): 177.CrossRefGoogle Scholar
See Wadman, , supra note 13.Google Scholar
See Food and Drug Administration, supra note 1.Google Scholar
See Food and Drug Administration, supra note 3.Google Scholar
Harris, J. W., “The Declining State of Pharma/Biotech Productivity: Microdosing as a New Tool That May Increase Efficiency,” keynote address presented at the New Tools for Early PK/PD and Efficacy Data: Microdosing, PET, and Exploratory INDs, hosted by the Institute for International Research and the University of the Sciences – Philadelphia, San Francisco, January 18–20, 2006.Google Scholar
See Twombly, , supra note 10.Google Scholar
Combes, R. D. et al. , “Early Microdose Drug Studies in Human Volunteers Can Minimise Animal Testing: Proceedings of a Workshop Organised by Volunteers in Research and Testing,” European Journal Pharmaceutical Sciences 19, no. 1 (2003): 111.CrossRefGoogle Scholar
See Lappin, , supra note 8.Google Scholar
Walker, D. E., “The Use of Pharmacokinetic and Pharmacodynamic Data in the Assessment of Drug Safety in Early Drug Development,” British Journal of Clinical Pharmacology 58, no. 6 (2004): 601–8.CrossRefGoogle Scholar
See Twombly, , supra note 10.Google Scholar
Collins, J. M., “Imaging and Other Biomarkers in Early Clinical Studies: One Step at a Time or Re-Engineering Drug Development?” Journal of Clinical Oncology 23, no. 24 (2005): 5417–8.CrossRefGoogle Scholar
Latour, B., Science in Action (Cambridge: Harvard University Press, 1987).Google Scholar
Bouchie, A., “Clinical Trial Data: To Disclose or Not to Disclose,” Nature Biotechnology 24, no. 9 (2006): 1058–60.CrossRefGoogle Scholar
General Principles of the IND Submission, 21 CFR 312.22Google Scholar
See Food and Drug Administration, supra note 1; De Gruttola, V. G. et al. , “Considerations in the Evaluation of Surrogate Endpoints in Clinical Trials: Summary of a National Institutes of Health Workshop,” Control Clinical Trials 22 (2001): 485502; Bast, R. C. et al. , “Translational Crossroads for Biomarkers,” Clinical Cancer Research 11, no. 17 (2005): 6103–8; Kaiser, J., “Private + Public = Progress,” Science 314, no. 5797 (2006): 235; Kummar, S. Gutierrez, M. Doroshow, J. H. Murgo, A. J., “Drug Development in Oncology: Classic Cytotoxics and Molecularly Targeted Agents,” British Journal of Clinical Pharmacology 62, no. 1 (2006): 15–26.CrossRefGoogle Scholar
See Branca, , supra note 24.Google Scholar
Food and Drug Administration Guidance for Industry, Draft Guidance, INDs – Approaches to Complying with CGMP during Phase 1, January 2006, available at <http://www.fda.gov/CDER/guidance/6164dft.htm> (last visited August 2, 2007).+(last+visited+August+2,+2007).>Google Scholar