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U.S. FDA Drug Approvals for Breast Cancer: A Decade in Review
Shaily Arora1, Preeti Narayan1, Christy L Osgood1
1Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration, Silver Spring, Maryland.
Abstract:
Over the last decade, the treatment of patients with breast cancer has been greatly impacted by the approval of multiple drugs and indications. This summary describes 30 FDA approvals of treatments for breast cancer from 2010 to 2020. The trial design endpoints, results, and regulatory considerations are described for each approved indication. Of the 30 indications, 23 (76.6%) received regular and 7 (23.3%) received accelerated approval. Twenty-six approvals were granted in metastatic breast cancer (MBC) and four in early breast cancer. Approval decisions for the 26 MBC indications were initially supported by progression-free survival (PFS) in 21 (80.8%), overall survival (OS) or a combination of OS and PFS in two (7.7%), and objective response rate (ORR) in three (11.5%). The four approvals in early breast cancer utilized pathologic complete response (pCR) in one (25%) and invasive disease-free survival (iDFS) in three (75%) trials. Among the 30 indications, 22 received priority review, seven were granted Breakthrough Therapy Designation, and 10 applications participated in one or more pilot Oncology Center of Excellence regulatory review initiatives, including Real Time Oncology Review, Assessment Aid, and Project Orbis. FDA initiatives to advance breast cancer drug development are also described.
Insights
FDA approved 30 breast cancer treatments from 2010-2020, primarily for metastatic breast cancer (MBC) using progression-free survival (PFS) endpoints. Many received expedited review pathways, showcasing advancements in breast cancer drug development.
Area of Science:
- Oncology
- Pharmacology
- Regulatory Science
Background:
- Breast cancer treatment has evolved significantly with numerous new drug approvals.
- The period 2010-2020 saw substantial advancements in FDA-approved therapies for breast cancer.
Purpose of the Study:
- To summarize 30 FDA approvals for breast cancer treatments between 2010 and 2020.
- To analyze trial endpoints, results, and regulatory considerations for these approvals.
Main Methods:
- Review of 30 FDA drug approvals for breast cancer from 2010-2020.
- Analysis of trial design, endpoints (progression-free survival, overall survival, objective response rate, pathologic complete response, invasive disease-free survival), and regulatory pathways (regular, accelerated, priority review, Breakthrough Therapy Designation).
Main Results:
- 23 approvals were regular, 7 were accelerated.
- 26 approvals were for metastatic breast cancer (MBC), 4 for early breast cancer.
- Progression-free survival was a key endpoint for MBC approvals (80.8%); pathologic complete response and invasive disease-free survival were used for early breast cancer.
- Many indications benefited from expedited FDA review initiatives.
Conclusions:
- The decade saw significant progress in breast cancer drug approvals, with a focus on metastatic disease.
- FDA initiatives played a crucial role in advancing the development and approval of novel breast cancer therapies.
- Endpoint selection varied based on disease stage, reflecting tailored regulatory approaches.
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