The FDA's Project Optimus initiative is prompting pharmaceutical and biotechnology companies to rethink their approach to early-phase oncology trials, emphasizing the identification of optimal dosages rather than maximum tolerated doses. This shift aims to improve patient experience and quality of life by minimizing debilitating adverse events associated with higher treatment doses.
Optimizing Dosage in Early-Phase Trials
With newer classes of medicines like antibody-drug conjugates and bispecific antibodies requiring longer treatment durations, the focus on cumulative toxicity has become critical. Project Optimus encourages sponsors to characterize optimal cancer treatment dosages before initiating registrational studies, necessitating new strategies for planning and executing early-phase oncology trials.
Model-informed scenario planning, encouraged by the FDA, is proving beneficial in determining optimal dosages. Clinical teams are incorporating dose optimization cohorts in one or more tumor types at two or more dose levels to better evaluate and characterize appropriate dosages. This approach, while adding to sample size and timelines, provides a holistic view of safety, efficacy, pharmacokinetic/pharmacodynamics, biomarkers, and electronic patient-reported outcomes data.
Data Collection and Regulatory Engagement
Given the unique assets, program pipelines, and business objectives of each sponsor, it is vital to establish a strong foundation for planning. Biotech companies seeking licensing agreements with larger pharmaceutical companies need to understand the data requirements for such agreements. The licensee company must also gauge its risk tolerance in bringing in an asset without model-informed dose optimization insights.
Data completeness and quality are critical, requiring sponsors and study teams to ensure thorough review and cleaning of safety and efficacy data for enhanced modeling. Central lab teams need to perform biomarker assessments quickly and with high quality to prepare for simulations. The decision to institute central imaging during or after completion of dose optimization cohorts depends on the efficacy signals observed in these cohorts.
Open communication with the FDA is crucial for sponsors to demonstrate their efforts to comply with Project Optimus guidance. This is particularly important for smaller biotech companies that may have limited clinical trial, regulatory, or commercialization experience. CRO partners with experience working with the FDA can provide consultative guidance throughout the clinical journey, including preparing sponsors for meetings with the agency.
The Future of Oncology Drug Development
The oncology community recognizes the importance of transforming oncology drug development, with a greater emphasis on the patient's experience and quality of life. However, the industry is still in the early stages of understanding how early-phase dosage optimization can benefit patients while meeting the demands of a complex development landscape. Optimizing early-phase dosages can be a make-or-break situation for some biotech companies, requiring them to pull in key expertise and resources to enhance innovation in trial design and operations.
As the industry gains more experience with Project Optimus, it will need to consider how the FDA's guidance will influence other regulatory authorities' requirements and how sponsors can efficiently address new requirements for larger and more complex early-phase trials.
