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Khan T, Ali M, Khan A, Nisar P, Jan SA, Afridi S, Shinwari ZK. Anticancer Plants: A Review of the Active Phytochemicals, Applications in Animal Models, and Regulatory Aspects. Biomolecules 2019; 10:E47. [PMID: 31892257 PMCID: PMC7022400 DOI: 10.3390/biom10010047] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 12/24/2022] Open
Abstract
The rising burden of cancer worldwide calls for an alternative treatment solution. Herbal medicine provides a very feasible alternative to western medicine against cancer. This article reviews the selected plant species with active phytochemicals, the animal models used for these studies, and their regulatory aspects. This study is based on a meticulous literature review conducted through the search of relevant keywords in databases, Web of Science, Scopus, PubMed, and Google Scholar. Twenty plants were selected based on defined selection criteria for their potent anticancer compounds. The detailed analysis of the research studies revealed that plants play an indispensable role in fighting different cancers such as breast, stomach, oral, colon, lung, hepatic, cervical, and blood cancer cell lines. The in vitro studies showed cancer cell inhibition through DNA damage and activation of apoptosis-inducing enzymes by the secondary metabolites in the plant extracts. Studies that reported in vivo activities of these plants showed remarkable results in the inhibition of cancer in animal models. Further studies should be performed on exploring more plants, their active compounds, and the mechanism of anticancer actions for use as standard herbal medicine.
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Affiliation(s)
- Tariq Khan
- Department of Biotechnology, University of Malakand, Chakdara 18800, Pakistan
| | - Muhammad Ali
- Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan; (P.N.); (S.A.); (Z.K.S.)
| | - Ajmal Khan
- Department of Zoology, University of Buner, Sowari 17290, Pakistan;
| | - Parveen Nisar
- Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan; (P.N.); (S.A.); (Z.K.S.)
| | - Sohail Ahmad Jan
- Department of Biotechnology, Hazara University, Mansehra 21120, Pakistan;
| | - Shakeeb Afridi
- Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan; (P.N.); (S.A.); (Z.K.S.)
| | - Zabta Khan Shinwari
- Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan; (P.N.); (S.A.); (Z.K.S.)
- National Council for Tibb, Islamabad, Pakistan
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Nagai S, Ozawa K. Regulatory approval pathways for anticancer drugs in Japan, the EU and the US. Int J Hematol 2016; 104:73-84. [PMID: 27084259 DOI: 10.1007/s12185-016-2001-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 01/03/2023]
Abstract
The Pharmaceuticals and Medical Devices Agency and the Ministry of Health, Labour and Welfare in Japan and the US Food and Drug Administration are responsible for reviewing applications and approving drugs, medical devices, and regenerative medicines. In the EU, the European Medicines Agency is responsible for the centralized authorization procedure of medicines including oncologic drugs. In this review, we discuss general pathways for the marketing authorization of oncologic drugs and other drugs in Japan, the EU, and the US. There are still unmet medical needs in oncology, whereas scientific innovation and clinical development in oncology are rapid and active, suggesting a reasonable scope for new regulatory schemes for expedited review. Because regulatory schemes are also evolving rapidly, clinicians and academic researchers may have difficulty following the updated regulations in other regions as well as those in their own countries. However, keeping current with new regulations is important for the conduct of translational research and clinical development of new therapeutic products efficiently. This review is intended to help an international audience better understand the essence of the regulatory frameworks for the marketing authorization of oncologic drugs in Japan, the EU, and the US.
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Affiliation(s)
- Sumimasa Nagai
- Division of Genetic Therapeutics, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 1088639, Japan.
| | - Keiya Ozawa
- Division of Genetic Therapeutics, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 1088639, Japan
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Ning YM, Maher VE. Food and Drug Administration process for development and approval of drugs and radiopharmaceuticals: treatments in urologic oncology. Urol Oncol 2015; 33:137-42. [PMID: 25613202 DOI: 10.1016/j.urolonc.2014.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 01/22/2023]
Abstract
Regulatory advice and assessment play an important role in the successful development of new drugs and radiopharmaceuticals for the treatment of urologic malignancies. Cooperation between the US Food and Drug Administration (FDA) and the pharmaceutical industry has led to the approval of more than 20 new urologic oncology products in the last 2 decades. Despite these advances, more effective treatments need to be developed and approved for the treatment of urologic malignancies. This review provides general information about the FDA's role in the development of investigational new drugs, with an emphasis on the regulatory process and the requirements for marketing approval. In addition, this review summarizes the products for the treatment of urologic malignancies that were approved by the FDA in the last 30 years and the key issues concerning urologic oncology products that were discussed publicly at Oncologic Drug Advisory Committee meetings in the past 10 years.
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Affiliation(s)
- Yang-Min Ning
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD.
| | - V Ellen Maher
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
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Maeda H, Kurokawa T. Acceptance of surrogate end points in clinical trials supporting approval of drugs for cancer treatment by the Japanese regulatory agency. Ann Oncol 2015; 26:211-216. [PMID: 25361994 DOI: 10.1093/annonc/mdu500] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study investigated the historic use of different end points to support approval of drugs for cancer treatment in Japan. PATIENTS AND METHODS Anticancer drugs approved between April 2001 and April 2014 were comprehensively investigated using publicly available information. RESULTS Before the revision of the guideline for oncology drugs in April 2006 in Japan, >80% of end points supporting approval were response rate and overall survival (OS) was not frequent. After the revision of the guideline in Japan, using OS in pivotal clinical trials applied for approval increased to more than approximately one-third of oncology drugs, although trials with an end point of response rate decreased. Regarding drugs for major cancers including non-small-cell lung cancer, gastric cancer, colorectal cancer, and breast cancer, survival was used as an end point in 44.0%, whereas surrogate end points were used in 56.0%. Exploration of potential factors for using surrogate end points other than survival carried out through determinations of odds ratios and 95% confidence intervals identified 'orphan drug designation in Japan' and 'accelerated approval by the U.S. Food and Drug Administration' as significant factors. CONCLUSIONS The revised guideline for oncology drugs in Japan requires the results of phase 3 studies with survival as an end point at the time of new drug application at least for major cancers. The regulatory agency in Japan also accepts surrogate end points as end points supporting approval besides survival; however, the number of surrogate end points has decreased after the revision of the guideline. We consider that accepting surrogate end points in the Japanese regulatory systems is important to approve oncology drugs quickly in Japan.
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Affiliation(s)
- H Maeda
- Graduate School of Pharmaceutical Sciences, Keio University, Tokyo; Astellas Pharma, Inc., Tokyo, Japan.
| | - T Kurokawa
- Graduate School of Pharmaceutical Sciences, Keio University, Tokyo
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Kudrin A. Challenges in the Clinical Development Requirements for the Marketing Authorization of New Medicines in Southeast Asia. J Clin Pharmacol 2013; 49:268-80. [DOI: 10.1177/0091270008329557] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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An Analysis of Guidance for Proper Usage Documents for Oncology Drugs in Japan. Pharmaceut Med 2012. [DOI: 10.1007/bf03262390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yonemori K, Hirakawa A, Ando M, Hirata T, Yunokawa M, Shimizu C, Katsumata N, Tamura K, Fujiwara Y. The notorious “drug lag” for oncology drugs in Japan. Invest New Drugs 2011; 29:706-12. [DOI: 10.1007/s10637-011-9638-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 01/24/2011] [Indexed: 11/30/2022]
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Yonemori K, Hirakawa A, Ando M, Hirata T, Shimizu C, Katsumata N, Tamura K, Fujiwara Y. Do investigators show selection biases when enrolling patients in phase I oncology registration trials? J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yonemori K, Hirakawa A, Ando M, Hirata T, Shimizu C, Katsumata N, Tamura K, Fujiwara Y. Compliance with Good Clinical Practice in oncology registration trials in Japan. Ann Oncol 2010; 22:1451-1456. [PMID: 21119030 DOI: 10.1093/annonc/mdq594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study aimed to examine the quality in oncology registration trials for new drug application (NDA) or supplemental new drug application (sNDA) as extensions of the indications for use in Japan based on Good Clinical Practice (GCP) audit findings. MATERIALS AND METHODS We collected audit reports of on-site GCP inspections for registration trials in 383 NDAs or sNDAs that were reviewed by the Pharmaceuticals and Medical Devices Agency between the fiscal years 2004 and 2009. RESULTS Among the 40 audits for oncology drug applications, the frequencies at which one or more deficiencies ascribed to institution, investigator, sponsor, and institutional review board were found to be 15 (37.5%), 13 (32.5%), 21 (52.5%), and 10 (25.0%), respectively. The exclusion of patients from the review objective due to serious violations of GCP in 40 audits for oncology drug applications was observed in 2 (5.0%) cases, whereas that in the remaining 343 audits for other drug applications was observed in 40 (11.7%) cases. CONCLUSION The overall compliance of GCP in oncology registration trials was moderately better than that in registration trials for other diseases, although there was no statistically significant difference between them.
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Affiliation(s)
- K Yonemori
- Department of Breast and Medical Oncology, National Cancer Center Hospital.
| | - A Hirakawa
- Department of Management Science, Graduate School of Engineering, Tokyo University of Science
| | - M Ando
- Department of Breast and Medical Oncology, National Cancer Center Hospital; Department of Clinical Trial Coordination and Developmental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - T Hirata
- Department of Breast and Medical Oncology, National Cancer Center Hospital
| | - C Shimizu
- Department of Breast and Medical Oncology, National Cancer Center Hospital
| | - N Katsumata
- Department of Breast and Medical Oncology, National Cancer Center Hospital
| | - K Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital
| | - Y Fujiwara
- Department of Breast and Medical Oncology, National Cancer Center Hospital; Department of Clinical Trial Coordination and Developmental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
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Hynes KI, Rice CA. Provision of Hospital Pharmacy Services for Clinical Drug Trials. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2010. [DOI: 10.1002/j.2055-2335.2010.tb00564.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kay I Hynes
- Drug Information & Clinical Trials, The Royal Children's Hospital; Parkville
| | - Carol A Rice
- Peter MacCallum Cancer Centre; East Melbourne Victoria
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Yonemori K, Hirakawa A, Komiyama N, Kouno T, Ando M, Fujiwara Y, Urano T, Akagawa H, Maruyama H, Toyoshima S. Participation of elderly patients in registration trials for oncology drug applications in Japan. Ann Oncol 2010; 21:2112-2118. [PMID: 20332138 DOI: 10.1093/annonc/mdq070] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the age-based enrollment of cancer patients into registration trials of new drug applications or expanding the indications for use. MATERIALS AND METHODS The data from 234 registration trials in Japan and overseas of 43 drugs, which were reviewed by the Pharmaceuticals and Medical Devices Agency and approved by the Ministry of Health, Labour and Welfare in Japan between 1999 and 2008, were retrospectively analyzed according to the age distribution of enrolled patients. The age distribution of the Japanese cancer population was derived from Cancer Statistics in Japan 2003 and Annual Report on Health, Labour and Welfare 2003-2004. RESULTS In the Japanese cancer population, the estimated median age of cancer patients is 70 years, and 66% of cancer patients are aged 65 years or more. The estimated median age of cancer patients in all registration trials conducted in Japan was 59 years, whereas it was 55 years in the registration trials conducted overseas. The proportion of patients aged 65 years or more enrolled in registration trials conducted in Japan was 35%; this number was 28% in registration trials conducted overseas. CONCLUSION Elderly patients are underrepresented in oncology registration trials in Japan.
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Affiliation(s)
- K Yonemori
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo; Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
| | - A Hirakawa
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo
| | - N Komiyama
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo
| | - T Kouno
- Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - M Ando
- Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Y Fujiwara
- Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - T Urano
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo
| | - H Akagawa
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo
| | - H Maruyama
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo
| | - S Toyoshima
- Office of New Drug V, Pharmaceuticals and Medical Devices Agency, Tokyo
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Casali P. The off-label use of drugs in oncology: a position paper by the European Society for Medical Oncology (ESMO). Ann Oncol 2007; 18:1923-5. [DOI: 10.1093/annonc/mdm517] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hori A, Shibata T, Kami M, Kusumi E, Narimatsu H, Kishi Y, Murashige N, Mori K. Age disparity between a cancer population and participants in clinical trials submitted as a new drug application of anticancer drugs in Japan. Cancer 2007; 109:2541-6. [PMID: 17477381 DOI: 10.1002/cncr.22721] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Underrepresentation of older patients in cancer clinical trials has been reported previously. METHODS To evaluate disparities in age between actual cancer patients and those enrolled in clinical trials, the authors examined all the review reports of the Pharmaceuticals and Medical Devices Agency, Tokyo, Japan, and summaries of data submitted by applicants for the approval of new cancer drugs and that of a partial change in approved cancer drugs. RESULTS Information regarding 68 clinical trials was available on the Internet. The median age of trial participants ranged from 33 years to 73 years and was older than 65 years in 13 trials, whereas the estimated median age of patients with all cancers was 69 years, and 64% of these individuals were age > or =65 years. The median age of trial participants was found to be lower than that of the patient population in 60 trials. The median difference in age between the 2 groups was 7 years (range, -16 to +33). With regard to molecular-targeting agents (16 trials) and hormonal agents (10 trials), trial participants were younger than the patient population in 25 of the 26 trials, with a median difference of 6 years (range, -9.5 to +20). The difference was larger for molecular-targeting agents (median, 9.5 years; range, birth-20 years) compared with hormonal agents (median, 2 years; range, -9.5 to +15). CONCLUSIONS The results of the current study show that participants in cancer clinical trials are younger than the actual Japanese cancer patient population.
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Affiliation(s)
- Akiko Hori
- Office of New Drug I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
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Affiliation(s)
- D J Kerr
- University of Oxford, Department of Clinical Pharmacology, Oxford, UK
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