Skip to main content

Oncologic Rare Disease Drug Development

  • Chapter
  • First Online:
Rare Disease Drug Development
  • 600 Accesses

Abstract

Recent advancements in technology have facilitated progress in attaining a greater understanding of cancers than ever before, transforming what used to be known as histological types of cancer into a large group of rare diseases. Alongside these discoveries, new druggable targets have been revealed, giving rise to a new wave of targeted therapies for new disease subtypes. These, together with the earlier known rare cancer types, form a large pool of rare diseases, for which drugs are developed under the Orphan Drug Act. In this chapter, we will discuss the segmentation of the larger oncology indications based on biomarkers, and the critical role of these biomarkers in the overall success of a drug candidate. We will examine the business opportunity for oncology drug makers focusing on rare cancer indications. We will also touch on the probability of success of drug development in the rare cancer indication space. Examples relevant to each section will outline important cases of drug development within this context.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 34.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 44.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 49.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Orphan drug designations and approvals, U.S. FDA. https://www.accessdata.fda.gov/scripts/opdlisting/oopd/. Accessed 27 Jan 2021.

  2. Christensen JG, Zou HY, Arango ME, Li Q, Lee JH, McDonnell SR, et al. Cytoreductive antitumor activity of PF-2341066, a novel inhibitor of anaplastic lymphoma kinase and c-Met, in experimental models of anaplastic large-cell lymphoma. Mol Cancer Ther. 2007;6(12 Pt 1):3314–22. https://doi.org/10.1158/1535-7163.

    Article  PubMed  Google Scholar 

  3. Advancing health through innovation: New drug therapy approvals 2020. U.S. FDA. https://www.fda.gov/media/144982/download.

  4. SEER cause-specific death classification, NIH SEER data, https://seer.cancer.gov/causespecific/. Accessed 27 Jan 2021.

  5. Hajdu SI. A note from history: landmarks in history of cancer, part 3. Cancer. 2012;118(4):1155–68. https://doi.org/10.1002/cncr.26320.

    Article  PubMed  Google Scholar 

  6. Vokinger KN, Kesselheim AS. Application of orphan drug designation to cancer treatments (2008–2017): a comprehensive and comparative analysis of the USA and EU. BMJ Open. 2019;9:e028634. https://doi.org/10.1136/bmjopen-2018-028634.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jawad MU, Extein J, Min EJ, Scully SP. Prognostic factors for survival in patients with epitheliod sarcoma: 441 cases from SEER database. Clin Orthop Relat Res. 2009;467(11):2939–48. https://doi.org/10.1007/s11999-009-0749-2.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74. https://doi.org/10.1016/j.cell.2011.02.013.

    Article  CAS  PubMed  Google Scholar 

  9. Hematology/oncology (cancer) approvals & safety notifications, U.S. FDA. https://www.fda.gov/drugs/resources-information-approved-drugs/hematologyoncology-cancer-approvals-safety-notifications. Accessed 27 Jan 2021.

  10. Horowitz KB, McGuire WL. Predicting response to endocrine therapy in human breast cancer: a hypothesis. Science. 1975;189(4202):726–7. https://doi.org/10.1126/science.168640.

    Article  Google Scholar 

  11. Perou C, Sørlie T, Eisen M, Van De Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406:747–52. https://doi.org/10.1038/35021093.

    Article  CAS  PubMed  Google Scholar 

  12. List of cleared or approved companion diagnostic devices, U.S. FDA. https://www.fda.gov/medical-devices/vitro-diagnostics/list-cleared-or-approved-companion-diagnostic-devices-vitro-and-imaging-tools. Accessed 2 Jan 2021.

  13. Soda M, Choi YL, Enomoto M, Takada S, Yamashita Y, Ishikawa S, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. Nature. 2007;448(7153):561–6. https://doi.org/10.1038/nature05945.

    Article  CAS  PubMed  Google Scholar 

  14. McDermott U, Iafrate AJ, Gray NS, et al. Genomic alterations of anaplastic lymphoma kinase may sensitize tumors to anaplastic lymphoma kinase inhibitors. Cancer Res. 2008;68:3389–95. https://doi.org/10.1158/0008-5472.

    Article  PubMed  Google Scholar 

  15. Kwak EL, Bang YJ, Camidge DR, Shaw AT, Solomon B, Maki RG, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010;363(18):1693–703. https://doi.org/10.1056/NEJMoa1006448.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Camidge DR, Bang YJ, Kwak EL, Iafrate AJ, Varella-Garcia M, Fox SB, et al. Activity and safety of crizotinib in patients with ALK-positive non-small-cell lung cancer: updated results from a phase 1 study. Lancet Oncol. 2012;13(10):1011–9. https://doi.org/10.1016/S1470-2045(12)70344-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kim D, Ahn M, Yang P, Liu X, De Pas T, Crino L, Lanzalone S, et al. Updated results of a global phase II study with crizotinib in advanced ALK-positive non-small cell lung cancer (NSCLC). Ann Oncol. 2012;23(s9):IX402. https://doi.org/10.1016/S0923-7534(20)33871-0.

    Article  Google Scholar 

  18. Miller KL. Do investors value the FDA orphan drug designation? Orphanet J Rare Dis. 2017;12:114. https://doi.org/10.1186/s13023-017-0665-6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Miller KL, Lanthier M. Investigating the landscape of US orphan product approvals. Orphanet J Rare Dis. 2018;13:183. https://doi.org/10.1186/s13023-018-0930-3.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Prasad V, Mailankody S. Research and development spending to bring a single cancer drug to market and revenues after approval. JAMA Intern Med. 2017;177(11):1569–75. https://doi.org/10.1001/jamainternmed.2017.3601.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Saluja R, Arciero VS, Cheng S, McDonald E, Wong WWL, Cheung MC, Chan KKW. Examining trends in cost and clinical benefit of novel anticancer drugs over time. J Oncol Pract. 2018;14(5):e280–94. https://doi.org/10.1200/JOP.17.00058.

    Article  PubMed  Google Scholar 

  22. Novartis beats Merck KGaA to U.S. finish line with targeted lung cancer drug Tabrecta. https://www.fiercepharma.com/pharma/novartis-beats-merck-kgaa-to-finish-line-targeted-lung-cancer-drug-capmatinib. Accessed 27 Jan 2021.

  23. Arkenau HT, Kelly K, Patel MR, Neuteboom B, Speit I, Chin K, et al. Phase I JAVELIN solid tumor trial of avelumab (MSB0010718C), an anti-PD-L1 antibody: safety and pharmacokinetics. Ann Oncol. 2015;25(s8):VIII1. https://doi.org/10.1093/annonc/mdv513.08.

    Article  Google Scholar 

  24. Hughes MP, Hardee ME, Cornelius LA, Hutchins LF, Becker JC, Gao L. Merkel cell carcinoma: epidemiology, target, and therapy. Curr Dermatol Rep. 2014;3(1):46–53. https://doi.org/10.1007/s13671-014-0068-z.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Endpoints. FDA’s Janet Woodcock: the clinical trials system is ‘broken’. https://endpts.com/fdas-janet-woodcock-the-clinical-trials-system-is-broken/. Accessed 27 Jan 2021.

  26. Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D’Angelo SP, et al. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016;17(10):1374–85. https://doi.org/10.1016/S1470-2045(16)30364-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Cowey CL, Mahnke L, Espirito J, Helwig C, Oksen D, Bharmal M. Real-world treatment outcomes in patients with metastatic Merkel cell carcinoma treated with chemotherapy in the USA. Future Oncol. 2017;13(19):1699–710. https://doi.org/10.2217/fon-2017-0187.

    Article  CAS  PubMed  Google Scholar 

  28. Statement from FDA Commissioner Scott Gottlieb, M.D., on FDA’s new strategic framework to advance use of real-world evidence to support development of drugs and biologics. U.S. FDA, https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-fdas-new-strategic-framework-advance-use-real-world. Accessed 27 Jan 2021.

  29. Hay M, Thomas D, Craighead J, et al. Clinical development success rates for investigational drugs. Nat Biotechnol. 2014;32:40–51. https://doi.org/10.1038/nbt.2786.

    Article  CAS  PubMed  Google Scholar 

  30. Giannuzzi V, Landi A, Bosone E, Giznnuzzi F, Nirotri S, Torrent-Farnell J, et al. Failures to further developing orphan medicinal products after designation granted in Europe: an analysis of marketing authorisation failures and abandoned drugs. BMJ Open. 2017;7:e017358. https://doi.org/10.1136/bmjopen-2017-017358.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wong CH, Siah KW, Lo AW. Estimation of clinical trial success rates and related parameters. Biostatistics. 2019;20(2):273–86. https://doi.org/10.1093/biostatistics/kxx069.

    Article  PubMed  Google Scholar 

  32. Camacho LH, Chawla SP, Chua V, Abbadessa G, Komarnitsky PB, Lewis J. A phase I study of palifosfamide in combination with doxorubicin: safety and preliminary efficacy. J Clin Oncol. 2009;27(15_suppl):10577. https://doi.org/10.1200/jco.2009.27.15_suppl.

    Article  Google Scholar 

  33. Ryan CW, Merimsky O, Agulnik M, Blay JY, Schuetze SM, Van Tine BA, et al. PICASSO III: a phase III, placebo-controlled study of doxorubicin with or without palifosfamide in patients with metastatic soft tissue sarcoma. J Clin Oncol. 2016;34(32):3898–905. https://doi.org/10.1200/JCO.2016.67.6684.

    Article  CAS  PubMed  Google Scholar 

  34. Lee AT, Pollack SM, Huang P, Jones RL. Phase III soft tissue sarcoma trials: success or failure? Curr Treat Options Oncol. 2017;18(3):19. https://doi.org/10.1007/s11864-017-0457-1.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Constantinidou A, van der Graaf WTA. The fate of new fosfamides in phase III studies in advanced soft tissue sarcoma. Eur J Cancer. 2017;84:257–61. https://doi.org/10.1016/j.ejca.2017.07.043.

    Article  CAS  PubMed  Google Scholar 

  36. Jardim DL, Groves ES, Breitfeld PP, Kurzrock R. Factors associated with failure of oncology drugs in late-stage clinical development: a systematic review. Cancer Treat Rev. 2017;52:12–21. https://doi.org/10.1016/j.ctrv.2016.10.009.

    Article  PubMed  Google Scholar 

  37. Garcia VM, Cassier PA, de Bono J. Parallel anticancer drug development and molecular stratification to qualify predictive biomarkers: dealing with obstacles hindering progress. Cancer Discov. 2011;1(3):207–12. https://doi.org/10.1158/2159-8290.CD-11-0161.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Keren Moss .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moss, K., Palatka, J. (2021). Oncologic Rare Disease Drug Development. In: Huml, R.A. (eds) Rare Disease Drug Development. Springer, Cham. https://doi.org/10.1007/978-3-030-78605-2_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-78605-2_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78604-5

  • Online ISBN: 978-3-030-78605-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics