Originally published as JCO Early Release 10.1200/JCO.2008.19.9133 on March 2 2009

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Steps and Time to Process Clinical Trials at the Cancer Therapy Evaluation Program

From the Center for Management Research in Healthcare; Engineering Management Program, Owen Graduate School of Management, and School of Medicine, Vanderbilt University; Vanderbilt-Ingram Cancer Center, Nashville, TN; National Cancer Institute, Cancer Therapy Evaluation Program, Bethesda, MD.

Corresponding author: Joshua Crites, PhD, Center for Management Research in Healthcare, VU Box 351518 Station B, Nashville, TN 37235-1518; e-mail: joshua.crites{at}vanderbilt.edu.

Purpose To examine the processes and document the calendar time required for the National Cancer Institute's Cancer Therapy Evaluation Program (CTEP) and Central Institutional Review Board (CIRB) to evaluate and approve phase III clinical trials.

Methods Process steps were documented by (1) interviewing CTEP and CIRB staff regarding the steps required to activate a trial from initial concept submission to trial activation by a cooperative group, (2) reviewing standard operating procedures, and (3) inspecting trial records and documents for selected trials to identify any additional steps. Calendar time was collected from initial concept submission to activation using retrospective data from the CTEP Protocol and Information Office.

Results At least 296 distinct processes are required for phase III trial activation: at least 239 working steps, 52 major decision points, 20 processing loops, and 11 stopping points. Of the 195 trials activated during the January 1, 2000, to December 31, 2007, study period, a sample of 167 (85.6%) was used for gathering timing data. Median calendar days from initial formal concept submission to CTEP to trial activation by a cooperative group was 602 days (interquartile range, 454 to 861 days). This time has not significantly changed over the past 8 years. There is a high variation in the time required to activate a clinical trial.

Conclusion Because of their complexity, the overall development time for phase III clinical trials is lengthy, process laden, and highly variable. To streamline the process, a solution must be sought that includes all parties involved in developing trials.

Supported by Grant No. 3U10 CA 21115-32 from the National Cancer Institute (R.L.) Comis and by subcontract (D.M.D. and A.B.S.).

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

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