Jin Susan, Pazdur Richard, Sridhara Rajeshwari
All authors: US Food and Drug Administration, Silver Spring, MD.
J Clin Oncol. 2017 Nov 20;35(33):3745-3752. doi: 10.1200/JCO.2017.73.4186. Epub 2017 Oct 2.
Clinical trial eligibility criteria are necessary to define the patient population under study and improve trial safety. However, there are concerns that eligibility criteria for cancer clinical trials are too restrictive and limit patient enrollment in clinical trials. Recently, there have been initiatives to re-examine and modernize eligibility criteria for oncology clinical trials. To assess current eligibility requirements for cancer clinical trials, we have conducted a comprehensive review of eligibility criteria for commercial investigational new drug clinical trial applications submitted to the US Food and Drug Administration Office of Hematology and Oncology Products in 2015. Our findings suggest that eligibility criteria for current cancer clinical trials tend to narrowly define the study population and limit the study to lower-risk patients, which may not be reflective of the greater patient population outside of the study. We discuss potential areas for expanding eligibility criteria to include more patients in clinical trials and design options for clinical trials incorporating expanded eligibility criteria. The broadening of clinical trial eligibility criteria can be considered to better reflect the real-world patient population, improve clinical trial participation, and increase patient access to new investigational treatments.
临床试验入选标准对于界定所研究的患者群体及提高试验安全性是必要的。然而,有人担心癌症临床试验的入选标准过于严格,限制了患者参与临床试验。最近,已有举措重新审视肿瘤学临床试验的入选标准并使其现代化。为评估当前癌症临床试验的入选要求,我们对2015年提交给美国食品药品监督管理局血液学和肿瘤学产品办公室的商业性研究性新药临床试验申请的入选标准进行了全面审查。我们的研究结果表明,当前癌症临床试验的入选标准往往对研究人群进行狭义界定,并将研究局限于低风险患者,这可能无法反映研究之外的更广泛患者群体。我们讨论了扩大入选标准以将更多患者纳入临床试验的潜在领域,以及纳入扩大入选标准的临床试验的设计选项。可以考虑拓宽临床试验入选标准,以更好地反映真实世界的患者群体,提高临床试验参与度,并增加患者获得新研究性治疗的机会。