Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.
AAPS J. 2011 Jun;13(2):274-83. doi: 10.1208/s12248-011-9265-x. Epub 2011 Mar 30.
There have been some successes in qualifying biomarkers and applying them to drug development and clinical treatment of various diseases. A recent success is illustrated by a collaborative effort among the US Food and Drug Administration, the European Medicines Agency, and the pharmaceutical industry to provide a set of seven preclinical kidney toxicity biomarkers for drug development. Other successes include, but are not limited to, clinical biomarkers for cancer treatment and clinical management of heart transplant patients. The value of fully qualified surrogate endpoints in facilitating successful drug development is undisputed, especially for diseases in which the traditional clinical outcome can only be assessed in large, multi-year trials. Emerging biomarkers, including chemical genomic or imaging biomarkers, and measurement of circulating tumor cells hold great promise for early diagnosis of disease and as prognostic tests for managing treatment of chronic diseases such as osteoarthritis, Alzheimer disease, cardiovascular disease, and cancer. To advance the success of treating and managing these diseases, efforts are needed to establish the temporal relationship between changes in inflammatory or imaging biomarkers with the progression of the chronic disease, and in the case of cancer, between the extent of circulating cancer cells and tumor progression or remission.
在确定生物标志物并将其应用于各种疾病的药物开发和临床治疗方面已经取得了一些成功。最近的一个成功案例是美国食品和药物管理局、欧洲药品管理局和制药行业之间的合作,为药物开发提供了一套七种临床前肾脏毒性生物标志物。其他成功的例子包括但不限于癌症治疗的临床生物标志物和心脏移植患者的临床管理。完全合格的替代终点在促进药物开发成功方面的价值是毋庸置疑的,特别是对于那些传统的临床结果只能在大型多年试验中评估的疾病。新兴的生物标志物,包括化学基因组学或影像学生物标志物,以及循环肿瘤细胞的测量,为疾病的早期诊断以及作为慢性疾病(如骨关节炎、阿尔茨海默病、心血管疾病和癌症)的治疗管理的预后测试提供了很大的希望。为了提高治疗和管理这些疾病的成功率,需要努力确定炎症或影像学生物标志物的变化与慢性疾病进展之间的时间关系,在癌症的情况下,需要确定循环肿瘤细胞的程度与肿瘤进展或缓解之间的关系。