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EMA responds to criticism of its cancer drug approvals

Published on 17/10/17 at 10:13am

The EMA received a broadside just less than two week ago from a group of researchers that had studied data from cancer drug approvals, with the suggestion that just fewer than half failed to showed any statistically significant benefit.

The treatments analysed were from the period 2009 to 2013, and included a total of 48 treatments for 68 different indications. Of these indications, 39 were found to be ineffective at boosting quality of life or improving survival on initial application.

In an editorial accompanying the original editorial research, published in the BMJ, Vinay Prasad, Assistant Professor of Medicine at Oregon Health and Science University, stated: “The expense and toxicity of cancer drugs means we have an obligation to expose patients to treatment only when they can reasonably expect an improvement in survival or quality of life. The study by Davis and colleagues suggests we may be falling far short of this important benchmark.”

Francesco Pignatti, Head of Oncology, Haematology and Diagnostics at the EMA, responded through the BMJ to defend the EMA’s position:

“The findings by Davis et al. that several cancer drugs entered the European market without clear evidence of extending duration of survival or improving quality of life (QoL) are not surprising to anyone familiar with cancer drug development. It is well known that in many situations demonstrating a clear effect on survival or QoL is not feasible and a benefit can be shown on the basis of other endpoints.”

Pignatti broke down the reasons why the drugs are often approved by secondary endpoints into four points:

The first being that improvements to overall survival are difficult to detect, as the effect is often “diluted” by the control group in the trials being switched to the experimental treatment after progression.

Secondly, when there is high unmet medical need and “dramatic activity” is observed in objective response rate (tumour shrinkage) and response duration.

Thirdly, QoL is rarely used as an endpoint due to the difficulty in assessing this for individual patients.

And, lastly, due to the fact that some drugs are approved on incremental benefits, which the original study did not recognise.

Pignatti concluded, “We all strive to help patients live better and longer. However, restricting approvals of cancer drugs only to situations where there is indisputable evidence of improvement in survival or QoL will not improve the lives of cancer patients.”

Ben Hargreaves

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