{"title":"Experiences with dose finding in patients in early drug development: the use of biomarkers in early decision making.","authors":"S R Sultana, S Marshall, J Davis, B H Littman","doi":"10.1007/978-3-540-49529-1_5","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_5","url":null,"abstract":"<p><p>With the increasing cost and complexity of drug development, biomarkers will play an increasing role in the early phases. Biomarkers can be classified into target, mechanistic, or outcome with varying degrees of linkage to disease or treatment effect. They can be used to determine proof of concept by characterising the efficacy or safety profiles, or determining differentiation from any competitor drugs. PK/PD modelling of biomarker data for novel and marketed compounds can be used to predict outpatient dose response. Subsequent simulations may replace or reduce the size and cost of larger phase 2b outpatient studies. Two examples of biomarkers and PK/PD modelling used to characterise dose response are presented. Penile plethysmography (RigiScan Plus) in male erectile dysfunction and phenylephrine challenge urethral pressure in benign prostatic hyperplasia are used to reduce time and cost to reach major exploratory development decision points in these indications.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"65-79"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26374684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current stumbling blocks in oncology drug development.","authors":"C D Gimmi","doi":"10.1007/978-3-540-49529-1_10","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_10","url":null,"abstract":"<p><p>The prognosis of patients with metastatic cancer remains poor and treatment strategies including newer generations of chemotherapeutics have not significantly improved survival in most solid tumors. New approaches are required to further improve patient outcome and survival. Recently, a major leap in the understanding of the molecular mechanisms involved in signal transduction pathways that contribute to tumor growth have been identified as therapeutic targets. Particularly molecules involved in cellular proliferation (e.g., tyrosine kinases) and angiogenesis have been considered as targets for new treatment approaches. Novel therapeutics that specifically target kinase transduction pathways have shown promise as single agents and in combination with standard chemotherapy. In addition, results of recent studies with antiangiogenic monoclonal antibodies validate the use of this class of targeted therapeutics as an important new treatment modality in cancer. This review will focus on the drug development stumbling blocks of targeted treatment modalities in cancer.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"135-49"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26374689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacological prerequisites for PET ligands and practical issues in preclinical PET research.","authors":"S M Ametamey, M Honer","doi":"10.1007/978-3-540-49527-7_12","DOIUrl":"https://doi.org/10.1007/978-3-540-49527-7_12","url":null,"abstract":"<p><p>The development of PET radiopharmaceuticals for the non-invasive imaging of cancerous lesions, brain receptors, transporters and enzymes started more than 25 years ago. But till today no established algorithms exist to predict the success of a PET radiopharmaceutical. PET radioligand development is a challenging endeavor and predicting the success of PET ligand can be an elusive undertaking. A large number of PET radiopharmaceuticals have been developed for imaging, but so far only a few have found application as imaging agents in vivo in humans. Typically, the potential compound selected for development usually has the desired in vitro characteristics but unknown in vivo properties. The purpose of this chapter is to highlight some of the pharmacological constraints and prerequisites. Interspecies difference in metabolism and mass effects are discussed with examples. Finally, some of the practical issues related to laboratory animal imaging using anesthetic agents are also presented.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 62","pages":"317-27"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49527-7_12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26446559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Integration of pediatric aspects into the general drug development process.","authors":"K Rose","doi":"10.1007/978-3-540-49529-1_9","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_9","url":null,"abstract":"<p><p>Drug treatment of children is today less regularly based on formal clinical testing than adults. This has led to concerns regarding the safety and efficacy of pediatric medicines and resulted in public action in the United States and the European Union. The reasons for the increasing awareness include better understanding of child physiology, increased trust in GCP (good clinical practice), improved treatment of several severe childhood diseases, a changed view of the child as a subject in society, and more. The US has successfully introduced pediatric legislation that facilitates participation of children in phar maceutical innovation, and comparable approaches are now being discussed in Europe and Japan. While the outcome of the EU pediatric regulation in the near future is still open, the US pediatric legislation has been highly successful over the past 8 years and will be revised before it expires in September 2007. Innovative drugs are today being developed by global pharmaceutical companies. Adding pediatric aspects to this development process is a complex task where companies need to build up internal competency. Bureaucratic procedures that could be harmful to the companies' economic fundaments need to be avoided, and an appropriate ethical framework is required. This needs to be addressed by all partners in healthcare, including regulatory authorities, the pharmaceutical industry, pediatricians, patients and others in a sense of shared responsibility.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"123-34"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26374688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethnic aspects of cancer trials in Asia.","authors":"T W T Leung","doi":"10.1007/978-3-540-49529-1_12","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_12","url":null,"abstract":"<p><p>New drugs which have potential in cancer therapy are emerging every day and there is an increasing demand for trial patients all over the world. Asia being the most populated continent, as well as a large market for drug sales, has its own epidemiology of disease. The Asian races also have specific genomics that might affect response to drug treatment. In addition, there are cultural issues to be considered when considering clinical trials. In conclusion, more clinical trials should be done among Asian populations for the best results of drug treatment.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"165-9"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26374691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Network genomics.","authors":"T E Ideker","doi":"10.1007/978-3-540-31339-7_5","DOIUrl":"https://doi.org/10.1007/978-3-540-31339-7_5","url":null,"abstract":"<p><p>Network genomics is an emerging area of bioengineering which models the influence of genes (hence, genomics) in the context of a larger biomolecular system or network. A biomolecular network is a comprehensive collection of molecules and molecular interactions that regulate cellular function. Molecular interactions include physical binding events between proteins and proteins, proteins and DNA, or proteins and drugs, as well as genetic relationships dictating how genes combine to cause particular phenotypes. Thinking about biological systems as networks goes hand-in-hand with our ability to experimentally measure and define biomolecular interactions at large scale. Once we have catalogued all of the interactions present in a network, we may begin to ask questions such as: How many different molecules are bound by a typical protein? What is the topological structure of the network? How are signals transmitted through the network in response to internal and external events? Which parts of the network are evolutionarily conserved across species, and which parts differ? Perhaps most importantly, we can begin to use the interaction network as a storehouse of information from which to extract and construct computer-based models of cellular processes and disease.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 61","pages":"89-115"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-31339-7_5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26510661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[18F]fluoropyridines: From conventional radiotracers to the labeling of macromolecules such as proteins and oligonucleotides.","authors":"F Dollé","doi":"10.1007/978-3-540-49527-7_5","DOIUrl":"https://doi.org/10.1007/978-3-540-49527-7_5","url":null,"abstract":"<p><p>Molecular in vivo imaging with the high-resolution and sensitive positron emission tomography (PET) technique requires the preparation of a positron-emitting radiolabeled probe or radiotracer. For this purpose, fluorine-18 is becoming increasingly the radionuclide of choice due to its adequate physical and nuclear characteristics, and also because of the successful use in clinical oncology of 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), which is currently the most widely used PET-radiopharmaceutical and probably the driving force behind the growing availability and interest for this positron-emitter in radiopharmaceutical chemistry. With a few exceptions, radiofluorinations involving fluorine-18 of high specific radioactivity (e.g. > 185 GBq/micromole) had, until recently, been limited to nucleophilic substitutions in homoaromatic and aliphatic series with [18F]fluoride. Considering chemical structures showing a fluoropyridinyl moiety, nucleophilic heteroaromatic substitution at the ortho-position with no-carrier-added [l8F]fluoride, as its K[18F]F-K222 complex, appears today as a highly efficient method for the radiosynthesis of radiotracers and radiopharmaceuticals. This chapter summarizes the recent applications of this methodology and highlights its potential in the design and preparation of, often drug-based, fluorine-18-labeled probes of high specific radioactivity for PET imaging, including macromolecules of biological interest such as peptides, proteins and oligonucleotides.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 62","pages":"113-57"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49527-7_5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26446664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dose finding in pediatric patients.","authors":"G Henze","doi":"10.1007/978-3-540-49529-1_8","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_8","url":null,"abstract":"<p><p>It is generally agreed that satisfactory safety and effectiveness of pharmaceutical products for children and adolescents have not yet been established. This applies in particular to anti-cancer drugs and even to those having successfully been used for many years in multidrug chemotherapy protocols for childhood cancer. For example, nephroblastoma or Wilms' tumor is one of the typical and frequent forms of childhood cancer occurring at a median age of about 3 years. Standard therapy for Wilms' tumor is the combination of vincristine and actinomycin D; survival is about 85%. For actinomycin D, the summary of product characteristics states that one contraindication is children aged below 6-12 months. If this would be considered and respected it would mean that a substantial proportion of children with Wilms' tumor would not be treated and thus a proven curative therapy would be withheld. The current situation in pediatrics is that off-label use has become a common practice: in private practice about 20% of prescriptions are off-label, in children's hospitals approximately 40%-50% with 50%-70% in pediatric oncology and more than 90% in neonatology (Conroy et al. 1999, 2000, 2003; Turner et al. 1996, 1998; McIntyre et al. 2000). These conditions are more or less tolerated by the authorities although they are beyond legality. The reason is that appropriate clinical trials like those in adults have not been conducted in children and drugs have therefore not been licensed.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"111-21"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26374687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Exploratory IND: a new regulatory strategy for early clinical drug development in the United States.","authors":"N Sarapa","doi":"10.1007/978-3-540-49529-1_11","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_11","url":null,"abstract":"<p><p>Optimizing exploratory drug development by means of doing first-in-human studies earlier is an attractive option for pharmaceutical sponsors to select more successful drug candidates. Traditional registration-driven clinical phase 1 programs could be preceded by early human screening studies with subpharmacological single doses (microdoses) or with low pharmacologically active doses of one or several lead candidates, whereby human pharmacokinetic and pharmacodynamic data are generated very early. Such low doses are not expected to have clinically significant toxic potential, so early human screening studies may be supported by abbreviated nonclinical safety packages. Recent U.S. FDA draft guidance (April 2005) regulated early human screening studies conducted under the exploratory IND. The author outlines the features of the study design, dose selection, and nonclinical safety packages required in support of exploratory IND studies in humans. In appropriately chosen cases, exploratory IND could allow for patients' quicker access to safer and more efficacious doses of novel drugs, reduce attrition in clinical trials, and facilitate more economical drug development.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"151-63"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26374690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Smarter candidate selection--utilizing microdosing in exploratory clinical studies.","authors":"P Buchan","doi":"10.1007/978-3-540-49529-1_2","DOIUrl":"https://doi.org/10.1007/978-3-540-49529-1_2","url":null,"abstract":"<p><p>Microdosing offers a faster and potentially less expensive approach to obtaining human in vivo PK data in early clinical drug development. It encompasses the use of pharmacologically inactive doses of test drug in the low microgram range along with ultrasensitive assay methods (PET, AMS) to assess human exposure in order to extrapolate the PK of higher, clinically more relevant doses, assuming linear PK. This strategy allows early evaluation of systemic clearance, oral bioavailability as well as sources of intersubject variability and questions of specific metabolite formation. It does take advantage of reduced regulatory requirements of preclinical safety studies, bulk drug synthesis (CMC requirements) and easier formulation options, e.g., as part of an exploratory IND; however, this is counterbalanced by a need to synthesize radiolabeled test compound and the development of a sophisticated analytical method. Ongoing studies will determine the predictability of human PK using Microdosing methods.</p>","PeriodicalId":80277,"journal":{"name":"Ernst Schering Research Foundation workshop","volume":" 59","pages":"7-27"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-540-49529-1_2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26375264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}