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The changing landscape of clinical trial and approval processes in China

Abstract

In the past decade, the standards of clinical trials in China have moved closer to international standards, thus encouraging the development of innovative drugs. However, a large backlog of pending applications for both drug approval and clinical trial registration has arisen owing to the complexity of the approval process, the volume of applications and a lack of staff available to process these applications, among other reasons. To improve the drug approval process, a 'four-colour-light' strategy was introduced. Different drugs are classified into redefined categories of innovative and generic drugs, with priority being given to approval decisions concerning innovative drugs. Other improvement strategies are now also being implemented, including the development of a new clinical trial approval system and several measures designed to encourage greater participation of Chinese researchers and research centres in international clinical trials. In this Perspective, the changing landscape of clinical approval in China is described, including the difficulties that drug approval authorities face in this rapidly developing nation and the novel strategies that are being used to find solutions.

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References

  1. National Center for Drug Evaluation (CDE). 2014 Annual Report on Drug Evaluation in China. Yao xue Jin Zhan [Progress In Pharmaceutical Sciences] 39, 241–250 (2015).

  2. China Food and Drug Administration. Guidelines for electronic data collection techniques in clinical trials. sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0087/160963.html (in Chinese) (2016).

  3. China Food and Drug Administration. Administrative measures for drug registration. eng.sfda.gov.cnhttp://eng.sfda.gov.cn/WS03/CL0768/61645.html (2007).

  4. Li, J. et al. Randomized, double-blind, placebo-controlled phase III trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction. J. Clin. Oncol. 34, 1448–1454 (2016).

    Article  CAS  PubMed  Google Scholar 

  5. Kaufman, H. L., Kohlhapp, F. J. & Zloza, A. Oncolytic viruses: a new class of immunotherapy drugs. Nat. Rev. Drug Discov. 14, 642–662 (2015).

    Article  CAS  PubMed  Google Scholar 

  6. Sheridan, C. First oncolytic virus edges towards approval in surprise vote. Nat. Biotechnol. 33, 569–570 (2015).

    Article  CAS  PubMed  Google Scholar 

  7. Parry, J. Queue for drug registrations grows longer in China. BMJ 350, h1596 (2015).

    Article  PubMed  Google Scholar 

  8. Wu, Y. L., Zhang, H. & Yang, Y. Cancer drug development in China: recent advances and future challenges. Drug Discov. Today 20, 766–771 (2015).

    Article  PubMed  Google Scholar 

  9. China Food and Drug Administration. CFDA issued Announcement on Several Policies Pertaining to the Review & Approval of Drug Registration. CCPIEhttp://www.ccpie.org/news/download/2015pharm-13.pdf (2015).

  10. China Food and Drug Administration. Notice of the director-general on the publication of technical guidelines for the management of clinical trial data (No. 112 of 2016). sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0087/160961.html (in Chinese) (2016).

  11. China Food and Drug Administration. Notice of the director-general on guidelines for the planning and reporting of drug administration and statistical analysis of drug clinical trials (No. 113 of 2016). sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0087/160962.html (in Chinese) (2016).

  12. Deng, Y. Z., Wang, H. W. & Fu, H. J. Implementation of performance metrics in clinical trial data management. Yao Xue Xue Bao 50, 1488–1492 (in Chinese) (2015).

    PubMed  Google Scholar 

  13. Zhang, Z. Big data and clinical research: focusing on the area of critical care medicine in mainland China. Quant. Imaging Med. Surg. 4, 426–429 (2014).

    PubMed Central  PubMed  Google Scholar 

  14. Shi, Y. et al. Icotinib versus gefitinib in previously treated advanced non-small-cell lung cancer (ICOGEN): a randomised, double-blind phase 3 non-inferiority trial. Lancet Oncol. 14, 953–961 (2013).

    Article  CAS  PubMed  Google Scholar 

  15. Shi, Y. et al. Results from a multicenter, open-label, pivotal phase II study of chidamide in relapsed or refractory peripheral T-cell lymphoma. Ann. Oncol. 26, 1766–1771 (2015).

    Article  CAS  PubMed  Google Scholar 

  16. Gavine, P. R. et al. Volitinib, a potent and highly selective c-Met inhibitor, effectively blocks c-Met signaling and growth in c-MET amplified gastric cancer patient-derived tumor xenograft models. Mol. Oncol. 9, 323–333 (2015).

    Article  CAS  PubMed  Google Scholar 

  17. Zhang, Z. K. et al. Icaritin requires phosphatidylinositol 3 kinase (PI3K)/Akt signaling to counteract skeletal muscle atrophy following mechanical unloading. Sci. Rep. 6, 20300 (2016).

    Article  CAS  PubMed  Google Scholar 

  18. Zhao, H. et al. A novel anti-cancer agent Icaritin suppresses hepatocellular carcinoma initiation and malignant growth through the IL-6/Jak2/Stat3 pathway. Oncotarget 6, 31927–31943 (2015).

    PubMed Central  PubMed  Google Scholar 

  19. Zhou, C. et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 12, 735–742 (2011).

    Article  CAS  PubMed  Google Scholar 

  20. Wu, Y. L. et al. Erlotinib as second-line treatment in patients with advanced non-small-cell lung cancer and asymptomatic brain metastases: a phase II study (CTONG-0803). Ann. Oncol. 24, 993–999 (2013).

    Article  PubMed  Google Scholar 

  21. Zhou, Q. et al. Pemetrexed versus gefitinib as a second-line treatment in advanced nonsquamous nonsmall-cell lung cancer patients harboring wild-type EGFR (CTONG0806): a multicenter randomized trial. Ann. Oncol. 25, 2385–2391 (2014).

    Article  CAS  PubMed  Google Scholar 

  22. Zhou, C. et al. Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small-cell lung cancer (OPTIMAL, CTONG-0802). Ann. Oncol. 26, 1877–1883 (2015).

    Article  CAS  PubMed  Google Scholar 

  23. Simon, R., Geyer, S., Subramanian, J. & Roychowdhury, S. The Bayesian basket design for genomic variant-driven phase II trials. Semin. Oncol. 43, 13–18 (2016).

    Article  PubMed  Google Scholar 

  24. Menis, J., Hasan, B. & Besse, B. New clinical research strategies in thoracic oncology: clinical trial design, adaptive, basket and umbrella trials, new end-points and new evaluations of response. Eur. Respir. Rev. 23, 367–378 (2014).

    Article  PubMed  Google Scholar 

  25. Lopez-Chavez, A. et al. Molecular profiling and targeted therapy for advanced thoracic malignancies: a biomarker-derived, multiarm, multihistology phase II basket trial. J. Clin. Oncol. 33, 1000–1007 (2015).

    Article  CAS  PubMed  Google Scholar 

  26. Wildiers, H. et al. End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer — Alliance for Clinical Trials in Oncology — International Society Of Geriatric Oncology position article. J. Clin. Oncol. 31, 3711–3718 (2013).

    Article  PubMed  Google Scholar 

  27. Zhou, Q. A. Phase II cluster study of single-agent AUY922, BYL719, INC280, LDK378, and MEK162 in Chinese patients with advanced non-small cell lung cancer (NSCLC) [abstract]. J. Clin. Oncol. 32, TPS8122 (2014).

    Article  Google Scholar 

  28. Ke, E. E., Zhou, Q. & Wu, Y. L. Emerging paradigms in targeted treatments for Asian patients with NSCLC. Expert Opin. Pharmacother. 16, 1167–1176 (2015).

    Article  CAS  PubMed  Google Scholar 

  29. US National Library of Medicine. ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT02276027 (2016).

  30. Li, J., Tian, J., Ma, B. & Yang, K. N-Of-1 trials in China. Complement. Ther. Med. 21, 190–194 (2013).

    Article  PubMed  Google Scholar 

  31. Kim, E. S. et al. Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST): a randomised phase III trial. Lancet 372, 1809–1818 (2008).

    Article  CAS  PubMed  Google Scholar 

  32. Wu, Y. L. et al. Intercalated combination of chemotherapy and erlotinib for patients with advanced stage non-small-cell lung cancer (FASTACT-2): a randomised, double-blind trial. Lancet Oncol. 14, 777–786 (2013).

    Article  CAS  PubMed  Google Scholar 

  33. Ciuleanu, T. et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 374, 1432–1440 (2009).

    Article  CAS  PubMed  Google Scholar 

  34. Zhou, C. et al. BEYOND: a randomized, double-blind, placebo-controlled, multicenter, phase III study of first-line carboplatin/paclitaxel plus bevacizumab or placebo in Chinese patients with advanced or recurrent nonsquamous non-small-cell lung cancer. J. Clin. Oncol. 33, 2197–2204 (2015).

    Article  CAS  PubMed  Google Scholar 

  35. Paz-Ares, L. et al. Monotherapy administration of sorafenib in patients with non-small cell lung cancer (MISSION) trial: a phase III, multicenter, placebo-controlled trial of sorafenib in patients with relapsed or refractory predominantly nonsquamous non-small-cell lung cancer after 2 or 3 previous treatment regimens. J. Thorac. Oncol. 10, 1745–1753 (2015).

    Article  CAS  PubMed  Google Scholar 

  36. Lei, Y. Y. et al. Anaplastic lymphoma kinase variants and the percentage of ALK-positive tumor cells and the efficacy of crizotinib in advanced NSCLC. Clin. Lung Cancer 17, 223–231 (2016).

    Article  CAS  PubMed  Google Scholar 

  37. Lei, Y. Y. et al. Clinical efficacy of crizotinib in Chinese patients with ALK-positive non-small-cell lung cancer with brain metastases. J. Thorac. Dis. 7, 1181–1188 (2015).

    PubMed Central  PubMed  Google Scholar 

  38. Solomon, B. J. et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N. Engl. J. Med. 371, 2167–2177 (2014).

    Article  PubMed  Google Scholar 

  39. Schuler, M. et al. First-line afatinib versus chemotherapy in patients with non-small cell lung cancer and common epidermal growth factor receptor gene mutations and brain metastases. J. Thorac. Oncol. 11, 380–390 (2016).

    Article  PubMed  Google Scholar 

  40. Wu, Y. L. et al. Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-Lung 6): an open-label, randomised phase 3 trial. Lancet Oncol. 15, 213–222 (2014).

    Article  CAS  PubMed  Google Scholar 

  41. Yang, J. C. et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol. 16, 141–151 (2015).

    Article  CAS  PubMed  Google Scholar 

  42. Geater, S. L. et al. Symptom and quality of life improvement in LUX-Lung 6: an open-label phase III study of afatinib versus cisplatin/gemcitabine in Asian patients with EGFR mutation-positive advanced non-small-cell lung cancer. J. Thorac. Oncol. 10, 883–889 (2015).

    Article  CAS  PubMed  Google Scholar 

  43. Reinersman, J. M. et al. Frequency of EGFR and KRAS mutations in lung adenocarcinomas in African Americans. J. Thorac. Oncol. 6, 28–31 (2011).

    Article  PubMed  Google Scholar 

  44. Wu, Y. L. et al. Epidermal growth factor receptor mutations and their correlation with gefitinib therapy in patients with non-small cell lung cancer: a meta-analysis based on updated individual patient data from six medical centers in mainland China. J. Thorac. Oncol. 2, 430–439 (2007).

    Article  PubMed  Google Scholar 

  45. Kim, H. J. et al. Clinical investigation of EGFR mutation detection by pyrosequencing in lung cancer patients. Oncol. Lett. 5, 271–276 (2013).

    Article  CAS  PubMed  Google Scholar 

  46. Lynch, T. J. et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N. Engl. J. Med. 350, 2129–2139 (2004).

    Article  CAS  PubMed  Google Scholar 

  47. Cadranel, J. et al. Impact of systematic EGFR and KRAS mutation evaluation on progression-free survival and overall survival in patients with advanced non-small-cell lung cancer treated by erlotinib in a French prospective cohort (ERMETIC project — part 2). J. Thorac. Oncol. 7, 1490–1502 (2012).

    Article  CAS  PubMed  Google Scholar 

  48. Paez, J. G. et al. EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Science 304, 1497–1500 (2004).

    Article  CAS  PubMed  Google Scholar 

  49. Dogan, S. et al. Molecular epidemiology of EGFR and KRAS mutations in 3,026 lung adenocarcinomas: higher susceptibility of women to smoking-related KRAS-mutant cancers. Clin. Cancer Res. 18, 6169–6177 (2012).

    Article  CAS  PubMed  Google Scholar 

  50. China Food and Drug Administration. Opinions of the state council on reforming the examination and approval system for drugs and medical devices. sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0056/126821.html (in Chinese) (2015).

  51. China Food and Drug Administration. The national drug review and approval system reform work conference was held in Shanghai. sda.gov.cnhttp://www.cfda.gov.cn/WS01/CL0050/127500.html (in Chinese) (2015).

  52. Lu, X., Ning, Z., Li, Z., Cao, H. & Wang, X. Development of chidamide for peripheral T-cell lymphoma, the first orphan drug approved in China. Intractable Rare Dis. Res. 5, 185–191 (2016).

    Article  PubMed  Google Scholar 

  53. National Center for Drug Evaluation. Annual drug review report. cde.org.cnhttp://www.cde.org.cn/news.do?method=largeInfo&id=313528 (in Chinese) (2016).

  54. Announcement of the state food and drug administration on carrying out self-checking and checking of drug clinical trial data. sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0087/124800.html (in Chinese) (2016).

  55. Zhu, F. C. et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 381, 2024–2032 (2013).

    Article  CAS  PubMed  Google Scholar 

  56. Liao, G. et al. Phase III trial of a Sabin strain-based inactivated poliovirus vaccine. J. Infect. Dis. 214, 1728–1734 (2016).

    Article  PubMed  Google Scholar 

  57. Zeng, M. et al. Efficacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 386, 1457–1464 (2015).

    Article  CAS  PubMed  Google Scholar 

  58. Wu, S. et al. An adenovirus vaccine expressing ebola virus variant makona glycoprotein is efficacious in guinea pigs and nonhuman primates. J. Infect. Dis. 214, S326–S332 (2016).

    Article  CAS  PubMed  Google Scholar 

  59. China Food and Drug Administration. Opinions of the general administration of the people's republic of China on implementing the priority examination and approval of the drug registration application. sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0844/145260.html (in Chinese) (2016).

  60. China Food and Drug Administration. Notice of the general administration of the people's republic of China on releasing the work program for the reform of the classification of chemical drugs registration. sda.gov.cnhttp://www.sda.gov.cn/WS01/CL0087/146140.html (in Chinese) (2016).

  61. [CFDA Wu zhen: 3 years to solve the problem of drug approval]. Zhongguo Yaodian [Chinese pharmacies] (2015).

  62. Huang, J. et al. Icotinib in patients with pretreated advanced esophageal squamous cell carcinoma with EGFR overexpression or EGFR gene amplification: a single-arm, multicenter phase 2 study. J. Thorac. Oncol. 11, 910–917 (2016).

    Article  PubMed  Google Scholar 

  63. Zhao, Q. et al. Phase I study of icotinib hydrochloride (BPI-2009H), an oral EGFR tyrosine kinase inhibitor, in patients with advanced NSCLC and other solid tumors. Lung Cancer 73, 195–202 (2011).

    Article  PubMed  Google Scholar 

  64. Li, J. et al. Apatinib for chemotherapy-refractory advanced metastatic gastric cancer: results from a randomized, placebo-controlled, parallel-arm, phase II trial. J. Clin. Oncol. 31, 3219–3225 (2013).

    Article  CAS  PubMed  Google Scholar 

  65. Tian, S. et al. YN968D1 is a novel and selective inhibitor of vascular endothelial growth factor receptor-2 tyrosine kinase with potent activity in vitro and in vivo. Cancer Sci. 102, 1374–1380 (2011).

    Article  CAS  PubMed  Google Scholar 

  66. Dong, M. et al. Phase I study of chidamide (CS055/HBI-8000), a new histone deacetylase inhibitor, in patients with advanced solid tumors and lymphomas. Cancer Chemother. Pharmacol. 69, 1413–1422 (2012).

    Article  CAS  PubMed  Google Scholar 

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Zhou, Q., Chen, XY., Yang, ZM. et al. The changing landscape of clinical trial and approval processes in China. Nat Rev Clin Oncol 14, 577–583 (2017). https://doi.org/10.1038/nrclinonc.2017.10

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