Phase 0 clinical trials in oncology: an exploratory methodology for constructing a study with patients undergoing surgery for metastatic disease

Phase zero trials: a novel approach in drug development process

OBJECTIVE

The objective of this review is to explore the concept of phase 0, its contribution and also its practical guidance in drug development process. The process of drug development is protracted, complicated and requires lot of money. Phase 0 focuses on the aspect of microdosing, which determines the relation between PK & PD profile of drug; also selection of lead compound. Concept of phase 0 balances the planning of study scale between animal and human being, and creates a new way of defining phase I. Time is not too far when advance techniques and methods will be developed for the phase 0 studies to make it convenient and widely applicable in the design and development of majority of drugs.

CONCLUSION

Although studies are yet to be done for phase 0 trial, it can be recognized that phase 0 trials would provide an opportunity to generate essential human PK and PD data much earlier in a drug development process, which could be a major advantage in design and decision making for further clinical development of an agent.

Personalized therapy in endometrial cancer: challenges and opportunities

Early stage endometrial cancer is generally curable. However, progress in the treatment of advanced and recurrent endometrial cancer has been limited. This has led to a shift from the use of traditional chemotherapeutic agents and radiotherapy regimens to the promising area of targeted therapy, given the large number of druggable molecular alterations found in endometrial cancer. To maximize the effects of directed targeted therapy, careful molecular characterization of the endometrial tumor is necessary. This represents an important difference in the use of targeted therapy vs. traditional chemotherapy or radiation treatment. This review will discuss relevant pathways to target in endometrial cancer as well as the challenges that arise during development of a personalized oncology approach.

Phase 0 clinical trials in oncology new drug development

Research focus of pharmaceutical industry has expanded to a larger extent in last few decades putting many more new molecules, particularly targeted agents, for the clinical development. On the other hand, researchers are facing serious challenges due to high failure rates of new molecules in clinical studies. The United States Food and Drug Administration (FDA) in combination with academia and industry experts identified many factors responsible for failures of new molecules, and with a vision of taking traditional drug development model toward an innovative paradigm shift, issued regulatory guidance on conduct of exploratory investigational new drug (exploratory IND) studies, often called as phase 0 clinical trials, requiring reduced preclinical testing, which has special relevance to life-threatening diseases such as cancer. Phase 0 trials, utilizing much lower drug doses, provide an opportunity to explore the clinical behavior of new molecules very early in the drug development pathway, helping to identify the promising candidates and eliminating non-promising molecules, thus improving the efficiency of overall drug development with significant savings of resources. Being non-therapeutic in nature, these studies, however, pose certain ethical challenges requiring careful study designing and informed consent process. This article reviews the insights and perspectives for the feasibility, utility, planning, designing and conduct of phase 0 clinical trials, in addition to ethical issues and industrial perspective focused at oncology new drug development.