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Transcript of Clinical Cancer Research Theresa Higgins Cancer Center Beth Israel Deaconess Medical Center Boston,...
Clinical Cancer Research
Theresa HigginsCancer Center
Beth Israel Deaconess Medical Center Boston, MA
Drugs through Pipeline (From Birth to Market)
How long does it take a drug to get to market?
Timeline for Drug Development
Preclinical Research
At Least 5 Years
File “
Investi
gati
on
al N
ew
Dru
g” A
pp
licati
on
w
ith
FD
A
Clinical Studies
7 Years
Phase I
1.5 Years
Phase II
2 Years
Phase III
3.5 Years
File “
New
Dru
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pp
licati
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” w
ith
FD
A
Review by FDA
PostmarketingSurveillance
Ap
pro
val
1.5 Years Ongoing
Preclinical Research
At Least 5 Years Discovery and
early screening of compound
Large-scale synthesis
Animal Testing
File Investigational New Drug (IND) Application with FDA
Investigational New Drug A new drug, antibiotic drug, or biological drug that is used in a clinical investigation
A biological product used in vitro (test tube or artificial environment) for diagnostic purposes
Phase I: Screening for Safety 10-100 people,
typically healthy Seeking to learn
maximum safe dose of drug
Length: 1.5 yrs Cost: $10 Million
Phase II: Establishing Protocol 50-500 patients with the disease
being studied Define experimental conditions that
will allow Phase III to give a definitive result
Find the efficacy of treatment in the disease being studied.
Length: 2 yrs Cost: $20 Million +
Phase III: The Final Test 300-30,000 or
more patients with the disease being studied
Determine efficacy and tolerability relative to standard therapy.
Length: 3.5 years Cost: $45 Million
File “New Drug Application” with FDA
Application submitted by the manufacturer of a drug to the FDA for a license to market the drug for a specified indication
Review By FDA
Length: 1.5 Years Labeling Phase IV Trials
APPROVAL! Able to advertise and
sell your product on the market
Postmarketing Surveillance(Phase IV Trials)
Watch for adverse reactions and product defects
Time: Ongoing FDA usually provides strong
suggestions of Phase IV trials at time of approval
Ex. Prozac
What are the different types of clinical trials?
Treatment Trials Prevention Trials Screening Trials Quality of Life Trials
Who can participate in a clinical trial?
Inclusion/Exclusion criteria Age, gender, type and stage of
disease, previous treatment, medical conditions
Healthy vs. patient with illness
What are the benefits of participating in a clinical trial? Patient plays an active role in their
own health care Gain access to new research
treatment before they are widely available
Obtain expert medical care at leading health care facilities during the trial
Help others by contributing to medical research
What are the risks of participating in a clinical trial? There may be previously unknown side
effects to experimental treatment that can be unpleasant, serious or even life-threatening
The treatment may not be effective for the participant
The protocol may require more time commitment and submission to procedures that would not be considered standard of care.
What are side effects and adverse reactions?
Any undesired actions or effects of drug or treatment Headache, nausea, hair loss, skin
irritation, or other physical problems Immediate and long term side effects
Ex. Viagra
How is the safety of the participant protected?
Ethical and legal codes (Federal and State Regulations)
Institutional Review Board (IRB) Informed Consent Patient can leave the trial at any
time
Melanoma Trials
Currently working on Melanoma Clinical Trials for Phase II and III Research
Eligible Patients for Trials have Stage II-IV Disease
Melanoma The most serious form of skin cancer Rapidly increasing incidence (over
50,000 cases each year in the US) Originates in melanocytes Risk Factors
Fair or light skin One or more blistering sunburns as a child Family history of melanoma Abnormal Moles
AsymmetryMost early melanomas are asymmetrical: a line through the middle would not create matching halves. Common moles are round and symmetrical.
BorderThe borders of early melanomas are often uneven and may have scalloped or notched edges. Common moles have smoother, more even borders.
ColorCommon moles usually are a single shade of brown. Varied shades of brown, tan, or black are often the first sign of melanoma. As melanomas progress, the colors red, white and blue may appear.
DiameterEarly melanomas tend to grow larger than common moles - generally to at least the size of a pencil eraser (about 6mm, or 1/4 inch, in diameter).
ABCD’s of Melanoma
Staging of MelanomaStage I
Tumors that are 0-2.0mm without ulceration or 0-1.0mm with ulceration.
Treatment: Surgical excision with 1-2cm margins and possible Sentinel Lymph Node Biopsy
Staging of MelanomaStage II
Tumors that are 1.01mm or greater and are ulcerated or 2.01mm or more and are non-ulcerated
Treatment: Surgical excision, Wide Local Excision, Sentinel Lymph Node Biopsy
Staging of MelanomaStage III
Regional Disease: The primary tumor has satellite or in-transit metastasis or has spread to regional lymph nodes.
Treatment: Surgery to remove all of the tumor, including lymph node resection and in most cases biologic therapy and/or chemotherapy.
Staging of MelanomaStage IV
Distant Metastasis: Tumor has spread beyond the lymph nodes, usually to lung (70-80%), liver (54-77%), or brain (36-54%)
Treatment: Surgery, if possible. Biologic therapy and/or chemotherapy or participation in a clinical trial.
Current Research
Therapies that have shown efficacy in more advanced cancers are being tested to see if they help prevent the progression of a cancer at an earlier stage.
Job Opportunities with a Biology Degree Pharmaceutical Sales Marketing at a Biotech Firm Clinical Research International Sales FDA Medical Technology Safety for a Toxicology Lab in Biotech Technical Writing CDC (Center for Disease Control)
Questions???
Resources www.clinicaltrials.gov www.skincancer.org www.cancer.org www.mpip.org www.bfmelanoma.com www.chiron.com Zivin, Justin A. “Understanding Clinical
Trials” Scientific American. April 2000.