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JNCI Journal of the National Cancer Institute 2004 96(20):1500-1509; doi:10.1093/jnci/djh279
© 2004 by Oxford University Press
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© 2004 Oxford University Press

REVIEW

Accelerated Approval of Oncology Products: A Decade of Experience

Ramzi Dagher, John Johnson, Grant Williams, Patricia Keegan, Richard Pazdur

Affiliations of authors: Division of Oncology Drug Products (RD, JJ, GW, RP), Division of Therapeutic Biological Oncology Products (PK), Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, MD

Correspondence to: Ramzi Dagher, MD, HFD-150, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 1451 Rockville Pike, Rockville, MD 20852 (e-mail: dagherr{at}cder.fda.gov)

We review the regulatory history of the accelerated approval process and summarize the U.S. Food and Drug Administration experience with accelerated approvals in oncology. The accelerated approval regulations, promulgated in 1992, allow approval of drugs for serious or life-threatening diseases on the basis of a surrogate endpoint that is reasonably likely to predict clinical benefit, such as survival or symptom benefit, pending completion of studies designed to confirm clinical benefit, referred to as phase 4 commitments, which are required to be conducted with due diligence. From 1992 to 2004, 22 applications involving anticancer drugs or biologics were approved. Of these 22 applications, accelerated approval was granted to 15 on the basis of findings from studies without an active comparator (i.e., single-arm studies or studies comparing two dose levels) and to the remaining seven on the basis of one or more randomized studies. Of the 22 approved applications, six (i.e., applications for dexrazoxane, irinotecan, capecitabine, docetaxel, imatinib mesylate, and oxaliplatin) have had one or more indications converted to regular approval. This review reports information that was presented at an Oncologic Drugs Advisory Committee meeting held in March 2003; it also presents a discussion of accelerated approval study designs, the study populations evaluated in the accelerated approval and confirmatory settings, and the integration of accelerated approval into a comprehensive drug development plan.


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