A Benefit–Risk Analysis Approach to Capture Regulatory Decision‐Making: Non‐Small Cell Lung Cancer

Drug regulators around the world make decisions about drug approvability based on qualitative benefit–risk analyses. There is much interest in quantifying regulatory approaches to benefit and risk. In this work the use of a quantitative benefit–risk analysis was applied to regulatory decision‐making about new drugs to treat advanced non‐small cell lung cancer (NSCLC). Benefits and risks associated with 20 US Food and Drug Administration (FDA) decisions associated with a set of candidate treatments submitted between 2003 and 2015 were analyzed. For benefit analysis, the median overall survival (OS) was used where available. When not available, OS was estimated based on overall response rate (ORR) or progression‐free survival (PFS). Risks were analyzed based on magnitude (or severity) of harm and likelihood of occurrence. Additionally, a sensitivity analysis was explored to demonstrate analysis of systematic uncertainty. FDA approval decision outcomes considered were found to be consistent with the benefit–risk logic.

[1]  E. Basch,et al.  The Japanese version of the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE): psychometric validation and discordance between clinician and patient assessments of adverse events , 2018, Journal of Patient-Reported Outcomes.

[2]  R. Pazdur,et al.  Benefit-Risk Summary of Crizotinib for the Treatment of Patients With ROS1 Alteration-Positive, Metastatic Non-Small Cell Lung Cancer , 2016, The oncologist.

[3]  Sandra A Mitchell,et al.  Patient-Reported Outcomes in Cancer Clinical Trials: Measuring Symptomatic Adverse Events With the National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). , 2016, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[4]  Y. Shentu,et al.  Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial , 2016, The Lancet.

[5]  P. Keegan,et al.  FDA Approval of Gefitinib for the Treatment of Patients with Metastatic EGFR Mutation–Positive Non–Small Cell Lung Cancer , 2016, Clinical Cancer Research.

[6]  H. Borghaei,et al.  Nivolumab in Nonsquamous Non-Small-Cell Lung Cancer. , 2016, The New England journal of medicine.

[7]  C. Rudin,et al.  Medians and Milestones in Describing the Path to Cancer Cures: Telling "Tails". , 2016, JAMA oncology.

[8]  B. Moy,et al.  Announcing a New Journal Section: Community Outreach , 2015, The oncologist.

[9]  Mirjam Kretzschmar,et al.  Disability weights for the Global Burden of Disease 2013 study. , 2015, The Lancet. Global health.

[10]  C. Rudin,et al.  Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. , 2015, The New England journal of medicine.

[11]  K. Syrigos,et al.  Afatinib versus erlotinib as second-line treatment of patients with advanced squamous cell carcinoma of the lung (LUX-Lung 8): an open-label randomised controlled phase 3 trial. , 2015, The Lancet. Oncology.

[12]  L. Crinò,et al.  Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. , 2015, The New England journal of medicine.

[13]  W. Dempke,et al.  Improved overall survival following tyrosine kinase inhibitor treatment in advanced or metastatic non-small-cell lung cancer-the Holy Grail in cancer treatment? , 2015, Translational lung cancer research.

[14]  Sean Khozin,et al.  Overall response rate, progression-free survival, and overall survival with targeted and standard therapies in advanced non-small-cell lung cancer: US Food and Drug Administration trial-level and patient-level analyses. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  N. Ready,et al.  Surrogate clinical endpoints to predict overall survival in non-small cell lung cancer trials-are we in a new era? , 2015, Translational lung cancer research.

[16]  O. Ciani,et al.  The role of health technology assessment bodies in shaping drug development , 2014, Drug design, development and therapy.

[17]  Huanyu Chen,et al.  FDA approval summary: crizotinib for the treatment of metastatic non-small cell lung cancer with anaplastic lymphoma kinase rearrangements. , 2014, The oncologist.

[18]  M. Drummond,et al.  Comparative Effectiveness Research/Health Technology Assessment (HTA) Analyzing Overall Survival in Randomized Controlled Trials with Crossover and Implications for Economic Evaluation , 2014 .

[19]  W. Oh,et al.  Adverse event reporting in cancer clinical trial publications. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  R. McCormack,et al.  First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: a phase-IV, open-label, single-arm study , 2013, British Journal of Cancer.

[21]  S. Morris,et al.  The PCAST Report: Impact and Implications for the Pharmaceutical Industry , 2013, Clinical pharmacology and therapeutics.

[22]  J. Woodcock The PCAST Report on Pharmaceutical Innovation: Implications for the FDA , 2013, Clinical pharmacology and therapeutics.

[23]  Chih-Hsin Yang,et al.  Vandetanib plus pemetrexed for the second-line treatment of advanced non-small-cell lung cancer: a randomized, double-blind phase III trial. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  Michael Thomas,et al.  Phase III trial of vandetanib compared with erlotinib in patients with previously treated advanced non-small-cell lung cancer. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  B S Levitan,et al.  Development of a Framework for Enhancing the Transparency, Reproducibility and Communication of the Benefit–Risk Balance of Medicines , 2011, Clinical pharmacology and therapeutics.

[26]  S Walker,et al.  Refining the Benefit–Risk Framework for the Assessment of Medicines: Valuing and Weighting Benefit and Risk Parameters , 2011, Clinical pharmacology and therapeutics.

[27]  Yan Sun,et al.  Vandetanib plus docetaxel versus docetaxel as second-line treatment for patients with advanced non-small-cell lung cancer (ZODIAC): a double-blind, randomised, phase 3 trial. , 2010, The Lancet. Oncology.

[28]  Steven Pearson,et al.  Relative efficacy of drugs: an emerging issue between regulatory agencies and third-party payers , 2010, Nature Reviews Drug Discovery.

[29]  Nicholas Iannotti,et al.  Cetuximab and first-line taxane/carboplatin chemotherapy in advanced non-small-cell lung cancer: results of the randomized multicenter phase III trial BMS099. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  R. Ramlau,et al.  Overall survival with cisplatin–gemcitabine and bevacizumab or placebo as first-line therapy for nonsquamous non-small-cell lung cancer: results from a randomised phase III trial (AVAiL) , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[31]  Carmen Cadarso-Suárez,et al.  Multi-state models for the analysis of time-to-event data , 2009, Statistical methods in medical research.

[32]  A. Kiureghian,et al.  Aleatory or epistemic? Does it matter? , 2009 .

[33]  D. Lollar,et al.  Disability and Disability-Adjusted Life Years: Not the Same , 2009, Public health reports.

[34]  Edward S. Kim,et al.  Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST): a randomised phase III trial , 2008, The Lancet.

[35]  Alasdair Breckenridge,et al.  Balancing early market access to new drugs with the need for benefit/risk data: a mounting dilemma , 2008, Nature Reviews Drug Discovery.

[36]  Robert Gray,et al.  Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. , 2006, The New England journal of medicine.

[37]  Kevin Carroll,et al.  Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer) , 2005, The Lancet.

[38]  F. Lichtenberg The Expanding Pharmaceutical Arsenal in the War on Cancer , 2004 .

[39]  R T O'Neill,et al.  Secondary endpoints cannot be validly analyzed if the primary endpoint does not demonstrate clear statistical significance. , 1997, Controlled clinical trials.

[40]  C. E. Davis,et al.  Secondary endpoints can be validly analyzed, even if the primary endpoint does not provide clear statistical significance. , 1997, Controlled clinical trials.

[41]  P. J. Hakkinen,et al.  Risk analysis: A guide to principles and methods for analyzing health and environmental risks , 1990 .

[42]  E. S. Pearson,et al.  THE USE OF CONFIDENCE OR FIDUCIAL LIMITS ILLUSTRATED IN THE CASE OF THE BINOMIAL , 1934 .

[43]  Simeons ON CHRONIC INFLAMMATION OF THE UVEA. , 1829 .

[44]  A. Tsao Vandetanib Versus Placebo in Patients With Advanced Non–Small-Cell Lung Cancer After Prior Therapy With an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor: A Randomized, Double-Blind Phase III Trial (ZEPHYR) , 2012 .

[45]  H. H. Ku Notes on the Use of Propagation of Error Formulas , 2010 .

[46]  J. Samet,et al.  Food and Drug Administration , 2007, BMJ : British Medical Journal.

[47]  Sidney Addelman,et al.  trans-Dimethanolbis(1,1,1-trifluoro-5,5-dimethylhexane-2,4-dionato)zinc(II) , 2008, Acta crystallographica. Section E, Structure reports online.