Mi­nor­i­ty racial groups con­tin­ue to be dis­mal­ly rep­re­sent­ed in can­cer tri­als — study

Da­ta re­veal that dif­fer­ent racial and eth­nic groups — by na­ture and/or nur­ture — can re­spond dif­fer­ent­ly in terms of phar­ma­co­ki­net­ics, ef­fi­ca­cy, or safe­ty to ther­a­peu­tics, but this dis­par­i­ty is not nec­es­sar­i­ly ac­count­ed for in clin­i­cal tri­als. A fresh analy­sis of the last decade of US can­cer drug ap­provals sug­gests the trend con­tin­ues, ce­ment­ing pre­vi­ous re­search that sug­gests on­col­o­gy tri­als are woe­ful­ly un­der-rep­re­sen­ta­tive of the racial make­up of the re­al world.

The study, pub­lished in the jour­nal JA­MA On­col­o­gy, eval­u­at­ed 230 tri­als to see whether spon­sors re­port­ed the racial com­po­si­tion of the pa­tients en­rolled in their stud­ies, and how mi­nori­ties were rep­re­sent­ed (ver­sus their ac­tu­al pop­u­la­tion preva­lence) in clin­i­cal tri­als that led to can­cer drug ap­provals from 2008 to 2018.

Re­searchers from the Uni­ver­si­ty of British Co­lum­bia, the Uni­ver­si­ty of Texas MD An­der­son Can­cer Cen­ter, the Fred Hutchin­son Can­cer Cen­ter in Seat­tle and Bay­lor Uni­ver­si­ty found that 145 (63%) dis­closed at least one race — but a mea­ger 18 (7.8%) doc­u­ment­ed the four ma­jor races: White, Asian, Black and His­pan­ic.

Com­pared to the ac­tu­al make­up of US can­cer pa­tients — Blacks (22% of ex­pect­ed) and His­pan­ics (44% of ex­pect­ed) were un­der­rep­re­sent­ed com­pared with Whites (98% of ex­pect­ed) and Asians (438% of ex­pect­ed), the analy­sis found.

This pat­tern is con­sis­tent — even though the NIH re­quires that mi­nor­i­ty pop­u­la­tions be ap­pro­pri­ate­ly rep­re­sent­ed in clin­i­cal re­search. Cor­po­ra­tions, which car­ry the li­on’s share of drugs across the fin­ish line, are on­ly rec­om­mend­ed to shore up rep­re­sen­ta­tion by the FDA.

A study ex­plor­ing the rea­sons be­hind chron­ic un­der­rep­re­sen­ta­tion of mi­nori­ties in on­col­o­gy tri­als, pub­lished in 2016, cit­ed a sys­tem­at­ic re­view of late-stage can­cer tri­als from 1990 to 2000 and 2001 to 2010 showed that eth­nic mi­nori­ties, par­tic­u­lar­ly African-Amer­i­cans, were not ad­e­quate­ly rep­re­sent­ed.

In stud­ies con­duct­ed be­tween 2001 and 2010 that re­port­ed race/eth­nic­i­ty, re­view­ers found that 82.9% of par­tic­i­pants were White, 6.2% were African Amer­i­can, 3.3% were Asian, 2.2% were His­pan­ic, and 0.1% were Na­tive Amer­i­can. In tri­als con­duct­ed be­tween 1990 and 2000, 89% of par­tic­i­pants were White, 10.5% were African Amer­i­can, 0.4% were His­pan­ic, and 0.04% were Asian. Even though the pro­por­tion of White par­tic­i­pants de­creased across the two pe­ri­ods, Whites con­tin­ued to com­prise a large ma­jor­i­ty of par­tic­i­pants, and the pro­por­tion of African Amer­i­can par­tic­i­pants de­creased be­tween the pe­ri­ods 1990 to 2000 and 2001 to 2010, the re­searchers ex­trap­o­lat­ed. Low mi­nor­i­ty rep­re­sen­ta­tion re­sults from “pre­ventable and in­ter­linked poli­cies, prac­tices, and bar­ri­ers at the sys­tem, in­di­vid­ual, and in­ter­per­son­al lev­els,” they con­clud­ed.

The pat­tern of dis­pro­por­tion­ate en­roll­ment in tri­als test­ing treat­ments for can­cer — a dis­ease which there are pro­nounced racial and eth­nic dis­par­i­ties in in­ci­dence and mor­tal­i­ty — is es­pe­cial­ly con­cern­ing giv­en the new wave of check­point in­hibitors.

In a sep­a­rate study pub­lished this May, re­searchers found that Black pa­tients con­sti­tut­ed less than 4% of pa­tients re­cruit­ed across mul­ti­ple tri­als that sup­port­ed the ap­proval of im­mune check­point in­hibitors for lung can­cer. The dis­crep­an­cy was echoed in tri­als con­duct­ed in re­nal cell car­ci­no­ma and oth­er tu­mor types.

“The in­ad­e­quate rep­re­sen­ta­tion of mi­nor­i­ty pa­tients on im­munother­a­py clin­i­cal tri­als could per­pet­u­ate out­come dis­par­i­ty be­cause the unique bi­ol­o­gy of the host and the tu­mors from this sub­pop­u­la­tion is not ac­count­ed for as new treat­ment al­go­rithms to guide op­ti­mal use of im­munother­a­py are de­vel­oped for use in the re­al world,” the re­searchers sug­gest­ed.

Andre Kalil, AP Images

A 9/11-era Om­a­ha fa­cil­i­ty, an old Ebo­la drug, and the ubiq­ui­tous Dr. Fau­ci: In­side the first US nov­el coro­n­avirus tri­al

The first 11 coronavirus patients who arrived in Omaha last week, airlifted across the globe after two weeks quarantined on a cruise ship, showed only minor symptoms or none at all. And then one of them — or one of the couple of Americans who arrived later — got worse. He developed pneumonia, a life-threatening complication for coronavirus patients.

In a biocontainment room at the University of Nebraska Medical Center on Friday, doctors infused him with an experimental Gilead drug once developed for Ebola, called remdesivir. Or they gave him a placebo. For the first time in the US, neither he nor the doctors knew.

The first US novel coronavirus trial was underway and with it, a mad dash for an answer. Sponsored by the NIH, the study marked a critical point in the epidemic. Since the start of the outbreak, the agency had helped lead a global effort to contain the virus. Now, as it spread worldwide and the CDC issued warnings the US could see a major internal outbreak, they were looking at home.

“We don’t have too much time,” Andre Kalil, the trial’s lead investigator, told Endpoints News. “Everything’s moving really fast.”

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Grow­ing ac­cep­tance of ac­cel­er­at­ed path­ways for nov­el treat­ments: but does reg­u­la­to­ry ap­proval lead to com­mer­cial suc­cess?

By Mwango Kashoki, MD, MPH, Vice President-Technical, and Richard Macaulay, Senior Director, of Parexel Regulatory & Access

In recent years, we’ve seen a significant uptake in the use of regulatory options by companies looking to accelerate the journey of life-saving drugs to market. In 2018, 73% of the novel drugs approved by the U.S. Federal Drug Administration (FDA) were designated under one or more expedited development program categories (Fast Track, Breakthrough Therapy, Priority Review, and Accelerated Approval).ᶦ

Brian Stuglik (file photo)

Turn­ing fo­cus to clin­i­cal work, Ve­rastem ax­es 31 jobs, scales back can­cer drug pro­mo­tion af­ter dis­ap­point­ing sales

Months after taking the helm at Verastem Oncology, Brian Stuglik has a plan to take the biotech in a “new strategic direction” — but not before some layoffs.

Left out of an upbeat press release spelling out its clinical plans, and buried below news of a $100 million private placement in an SEC filing, is a planned restructuring that will claim 31 jobs. Alongside some other cost-saving measures, Verastem expects to cut expenses down by $70 million to $80 million per year.

Olivier Brandicourt (AP Images)

Ex-Sanofi chief Olivi­er Brandi­court, cur­rent Black­stone ad­vi­sor, jumps on Al­ny­lam board

Former Sanofi chief Olivier Brandicourt, who departed his post with an unexpected early retirement last year, has made his move — as most C-suite executives inevitably do — to become a director on the board of a biopharma company.

RNAi player Alnylam is Brandicourt’s destination. Meanwhile, the Cambridge, Massachusetts-based drugmaker — which pioneered the first approval in the field — also disclosed the retirement of Alnylam co-founder Dr. Paul Schimmel from its board.

Dan O'Day (AP Images)

UP­DAT­ED: A name emerges out of the Gilead M&A ru­mor mill, and it’s a can­cer biotech

After months of questions and speculation about when and if Gilead will make a major acquisition, a name has emerged.

The California-based drugmaker has approached Forty Seven Inc, a cancer biotech, with a takeover offer, Bloomberg News reports. With Forty Seven’s market cap at $2.3 billion, an acquisition would likely be Gilead’s largest since they acquired Kite Pharma for $11.9 billion in 2017.

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Biogen head of R&D Al Sandrock, Sangamo CEO Sandy Macrae

UP­DAT­ED: Bio­gen makes an­oth­er bold Alzheimer’s bet, drop­ping $350M up­front to part­ner with genome-edit­ing fo­cused Sang­amo

While the fate of Biogen’s resurrected Alzheimer’s drug aducanumab remains uncertain, the Cambridge, MA-based drugmaker is joining forces with genome editing company Sangamo Therapeutics to develop therapies for neurological conditions.

Sangamo is set to receive a meaty $350 million upfront in cash and stock and is eligible to receive up to $2.37 billion in milestone payments, in addition to royalties. In return, Biogen gets the rights to two Sangamo preclinical compounds: ST-501 (for use in tauopathies including Alzheimer’s disease) and ST-502 (for synucleinopathies including Parkinson’s disease).

“The partnership represents a lower-cost way to expand its work in neurologic disease,” Credit Suisse’s Evan Seigerman said in a note, referring to Biogen.

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Take­da swoops in to buy lit­tle biotech part­ner and its celi­ac drug poised to 'change stan­dard of care'

Having spent three years carefully grooming PvP Biologics and its drug for celiac disease, Takeda is happy enough with the proof-of-concept data to buy it all.

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Jim Wilson's gene ther­a­py start­up Pas­sage Bio bucks mar­ket sen­ti­ments, rais­ing up­sized $216M IPO

A coronavirus fear-induced bloodbath on the Nasdaq has not stopped Passage Bio from making a public debut — and an exuberant one.

By pricing an upsized offering at $18, the top of the range, the gene therapy biotech bagged $216 million from its IPO, 72% more than it’s originally penciled in.

The proceeds likely reflected confidence in Jim Wilson, who gathered all the tools he’s built over decades of gene therapy research to assemble the startup and teamed up with Frazier and OrbiMed to hone its focus on rare, monogenic disorders of the central nervous system. Just before the IPO, Deerfield partner Bruce Goldsmith took over from OrbiMed’s Stephen Squinto as CEO.

Spark los­es an­oth­er top ex­ec in the wake of $4.3B takeover by Roche — re­port

Days after bidding farewell to co-founder Kathy High, Spark Therapeutics — now operating under Roche — has one more opening on its C-suite.

Kathy Reape

Kathy Reape, who joined the Philadelphia-based biotech in 2016 as head of clinical R&D and became chief medical officer in 2018, is reportedly set to leave.

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