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Patient-Reported Outcomes Supporting Anticancer Product Approvals

Edwin P. Rock, Dianne L. Kennedy, Melissa H. Furness, William F. Pierce, Richard Pazdur, Laurie B. Burke

From the Office of Oncology Drug Products and Study Endpoints and Label Development Team, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD

Address reprint requests to Laurie B. Burke, RPh, MPH, Study Endpoints and Label Development, Center for Drug Evaluation and Research, Food and Drug Administration, Bldg 22, 10903 New Hampshire Ave, Silver Spring, MD 20993; e-mail: laurie.burke{at}fda.hhs.gov

In 2006, the US Food and Drug Administration (FDA) published draft guidance to provide recommendations for development, validation, implementation, and interpretation of patient-reported outcome (PRO) measures that can support treatment benefit claims in product labeling. Here, we summarize and discuss FDA approvals of anticancer products in the context of the draft guidance. We identified anticancer product approvals having efficacy claim(s) based at least in part on a PRO. In addition, we collated limitations of PRO instruments commonly submitted for regulatory review over the period from October 1, 2004 to September 30, 2006. From 1995 onward, nine indications were approved for seven anticancer products based at least in part on a PRO. In eight of nine approvals, PRO data supplemented other evidence of clinical benefit. In seven approvals, the PRO measured a single symptom or functional domain that was directly attributable to the treatment benefit observed in the disease. The FDA's draft PRO guidance describes principles that have been used in anticancer product approvals for more than a decade. PRO end points typically support treatment benefit claims that refer to a patient's symptoms or ability to function. Single-item PROs may be acceptable. PRO data should be both internally consistent and aligned with other evidence of clinical benefit. The FDA encourages sponsors to consult with the FDA early in the process of PRO development.

Presented in part at the Patient-Reported Outcomes Assessment in Cancer Trials (PROACT) Conference in Bethesda, MD, September 20-21, 2006.

Opinions expressed in this article are the views of the authors and do not reflect the official position of the US Food and Drug Administration.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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