Ekimoto H
Anticancer Drugs Dept, Nippon Kayaku Co., Ltd.
Gan To Kagaku Ryoho. 1997 Jan;24(2):229-37.
International harmonization of data to be submitted in order to receive governmental authorization for the release of new medicines (ICH) has been promoted by Japan, the USA and European countries. Because of this trend, the Japanese drug authority, the medical institutions which perform clinical trials of not yet authorized new drugs and the pharmaceutical companies which contract these trials to medical institutions, are now required to change greatly their conventional views concerning drug development. The trend towards ICH has also been having a great impact on the development of anti-cancer agents in Japan. The greatest impact of ICH is that it requires pharmaceutical companies to take responsibility for the planning, pursuit and management of clinical trials of new drugs. To meet this requirement, it is urgent that pharmaceutical companies educate and train staff members involved in drug development, so that they attain high levels of medical proficiency in the field concerned. It is also necessary for these companies to organize in house groups of specialists in making clinical trials, who can evaluate clinical data and make decisions about outcomes by themselves. At the same time, medical institutions are required to establish a system which supports the clinical trials carried out within the hospital, while meeting the appropriate guidelines. Thus, medical institutions are required to make greater efforts to ensure adequate disclosure of diagnosis of cancer to a patient, obtain informed consent from patients and develop a hospital system capable of conducting excellent clinical trials. The governmental authority related to drugs is required to improve drug administration, including streamlining regulations and providing consultation services concerning the appropriate strategy for particular clinical trials. If the relevant governmental authority, medical institutions, pharmaceutical companies and mass media cooperate with the goal of improving the environment and systems related to clinical trials, the current system of clinical trials will be improved significantly, allowing more scientific and ethical clinical trials. This, in turn, will promote the smoother development of anti cancer agents in this country. At present, both the views on and the manner of conducting clinical trials (especially phase I clinical trials) differ in Japan and Western countries. These differences cause differences in the scheduling of preclinical studies, possibly leading to delayed commencement of phase I clinical trials in Japan. Among these issues, the procedures for preclinical studies of safety and pharmacokinetics studies (absorption, distribution, metabolism and elimination of drugs) need to be internationally standardized as soon as possible.
日本、美国和欧洲国家推动了为获得政府批准新药上市而提交的数据的国际协调(国际人用药品注册技术协调会)。由于这一趋势,日本药品监管机构、开展未经批准新药临床试验的医疗机构以及将这些试验委托给医疗机构的制药公司,现在需要大幅改变他们关于药物研发的传统观念。国际人用药品注册技术协调会的趋势也对日本抗癌药物的研发产生了重大影响。国际人用药品注册技术协调会最大的影响是要求制药公司对新药临床试验的规划、实施和管理负责。为满足这一要求,制药公司迫切需要对参与药物研发的员工进行教育和培训,使他们在相关领域达到较高的医学专业水平。这些公司还需要组建内部的临床试验专家小组,他们能够自行评估临床数据并对结果做出决策。与此同时,医疗机构需要建立一个支持医院内开展的临床试验的系统,同时符合适当的指导原则。因此,医疗机构需要做出更大努力,确保向患者充分披露癌症诊断信息,获得患者的知情同意,并建立一个能够开展出色临床试验的医院系统。与药品相关的政府机构需要改进药品管理,包括简化法规并就特定临床试验的适当策略提供咨询服务。如果相关政府机构、医疗机构、制药公司和大众媒体为改善与临床试验相关的环境和系统这一目标而合作,当前的临床试验系统将得到显著改善,从而允许开展更科学、更符合伦理的临床试验。反过来,这将促进该国抗癌药物更顺利地研发。目前,日本和西方国家在临床试验(尤其是I期临床试验)的观点和方式上存在差异。这些差异导致临床前研究的时间安排不同,可能导致日本I期临床试验的启动延迟。在这些问题中,安全性临床前研究和药代动力学研究(药物的吸收、分布、代谢和排泄)的程序需要尽快实现国际标准化。