Implementation of the ICH E17 Guideline in Japan

The landscape of drug development evolves with the globalization of the health industry as an integral part of the economy as well as public health worldwide. It is recognized that there are major advantages of being involved in conducting Multi-Regional Clinical Trials (MRCTs) as a part of it: Increasing drug development efficiency, promoting local or regional clinical research, providing local regulatory authorities a large body of data including their own patients studied under the same standard to evaluate the medical product, benefiting citizen patients to access new drugs around the same times as other nations. For these reasons, participating in various MRCTs globally is a rising trend for China as an emergent country in its biopharmaceutical industry and medical-health policy. China has joined the ICH as a member country in 2017. ICH E-17 contains general principles of MRCTs but lacks specifics. In this article, we highlight pertinent design and analysis issues with MRCTs and discuss current common approaches from the statistical aspects.

Drug development has been globalized, and multi-regional clinical trial (MRCT) for regulatory submission has widely been conducted by many discovery based global pharmaceutical companies with the objective of reducing the time lag of launch in key markets and improve patient access to new and innovative treatments. Sponsors are facing several challenges while conducting multiregional clinical trials. Challenges under the heads statistics, clinical, regulatory operational, and ethics have been discussed. Regulators in different countries such as USA, EU-Japan, and China have issued guidance documents in respect of MRCT's. Lack of harmonization in the design and planning of MRCT is perceived to create a difficult situation to sponsors adversely affecting progressing MRCT in more and more discoveries. International conference on hormonisation (ICH) has initiated the process for having a harmonized guidance document on MRCT. This document is likely to be issued in early 2017.

To accelerate the drug development process and shorten approval time, the design of multiregional clinical trials (MRCTs) incorporates subjects from many countries/regions around the world under the same protocol. After showing the overall efficacy of a drug in all global regions, one can also simultaneously evaluate the possibility of applying the overall trial results to all regions and subsequently support drug registration in each of them. In this paper, we focus on a specific region and establish a statistical criterion to assess the consistency between the specific region and overall results in an MRCT. More specifically, we treat each region in an MRCT as an independent clinical trial, and each perhaps has different treatment effect. We then construct the empirical prior information for the treatment effect for the specific region on the basis of all of the observed data from other regions. We will conclude similarity between the specific region and all regions if the posterior probability of deriving a positive treatment effect in the specific region is large, say 80%. Numerical examples illustrate applications of the proposed approach in different scenarios.

ABSTRACTThe primary objective of a multiregional clinical trial (MRCT) is to assess the efficacy of all participating regions and evaluate the probability of applying the overall results to a specific region. The consistency assessment of the target region with the overall results is the most common way of evaluating the efficacy in a specific region. Recently, Huang et al. (2012) proposed an additional trial in the target region to an MRCT to evaluate the efficacy in the target ethnic (TE) population under the framework of simultaneous global drug development program (SGDDP). However, the operating characteristics of this statistical framework were not well considered. Therefore, a nested group sequential program for regional efficacy evaluation is proposed in this paper. It is an extension of Huang’s SGDDP framework and allows interim analysis after MRCT and in the course of local clinical trial (LCT) phase. It is able to well control the family-wise type I error in the program level and enhances the flexibility of the program. In LCT sample size estimation, we introduce virtual trial, which is transformed from the original program by using discounting factor, and an iteration method is employed to calculate the sample size and stopping boundaries of interim analyses. The proposed sample size estimation method is validated in the simulations and the effect of varied weight, effect size of TE population, and design setting is explored. Examples with normal end point, binary end point, and survival end point are shown to illustrate the application of the proposed nested group sequential program.

Globalized drug development studies, such as multiregional clinical trials (MRCTs), have attracted much attention due to their ability to expedite drug development and shorten the time lag of drug release. While observing the overall effect of a new drug, the region-specific effects to support drug registration in constituent regions can also be evaluated. Several challenges arise in conducting MRCTs, such as the heterogeneity in the variability of the primary endpoint across regions. However, most of the existing statistical methods assume a common variability, which may not be valid in practice due to differences across regions (eg, diversities in ethnicity or disparities in medical culture/practice). We present a statistical method for the design and evaluation of MRCTs to consider the heterogeneous variability across regions. We assessed the overall sample size requirement and addressed the region-specific sample size determination to establish the consistency of treatment effects between the specific region and the entire group. We demonstrate the proposed approach with numerical examples.

Editor's Note: In this Meeting Report, Tetsuomi Takano provides an excellent summary of 2 related tutorial sessions held at the DIA 6th Annual Conference in Japan for Asian New Drug Development (KFC Hall, Tokyo, Japan, April 27, 2012). The sessions focused on best practices for development regulatory affairs and clinical development related to multiregional clinical trials (MRCTs) in China, Korea and Taiwan. I am grateful to Mr Takano for this contribution to the journal, and I am sure readers will find it both interesting and educational. J. Rick Turner, Outgoing Editor-in-Chief .

This chapter illustrates the regulatory considerations for the implementation of the ICH E17 guideline in China that was released in 2019. Chinese regulators encourage the sponsors to apply the general principles in the guideline when multi-regional clinical trials (MRCTs) are planned and designed. This chapter discusses some common issues and challenges in practice encountered by the reviewers in the agency, like the totality of the evidence, pooling strategy, study with local enrollment extension, etc.

The multi-regional clinical trials (MRCTs) being administered in different regions of the world now play a major role in providing evidence for the efficacy and safety of new drugs amidst the simultaneous global development and worldwide registration of such drugs, in support of the expeditious availability of medical products to patients. However, such trials present considerable challenges as far as quality, design, implementation, analysis, and interpretation are concerned. In this article, we share our observations and lessons learned from the design, implementation, analysis, and interpretation of some MRCTs with case examples. Current Japanese regulatory guidance on MRCTs is introduced along with some suggestions for design, implementation, and interpretation.

Drug development has continued to progress over the past decades and the processes involved have become more complex. The basis for these changes include advances in substance analysis and production, targeted drug development and defined guidelines for the conduct of clinical trials. The aim of standardised quality requirements is to generate scientifically sound data in clinical trials while observing strict ethical rules. The conduct of clinical trials is governed by internationally established Good Clinical Practice (GCP) guidelines. For the protection of human beings directly involved, framework conditions must be established as guidelines to accompany the research process. At the same time, these regulatory requirements enable a quality criteria standard to be defined. However, those regulations form a major challenge for clinical study centres, since they affect current clinical practice considerably. The objective of this paper is, on the one hand, to clarify the historical background relating to the development of clinical trials and the corresponding legal guidelines, on the other hand, to discuss consequences for clinical practice.

Globalization of oncology drug development has accelerated the adoption of multiregional clinical trials (MRCTs) as pivotal evidence for regulatory approvals in major markets, including Japan. While MRCTs enhance efficiency and generalizability, they introduce challenges related to inter-ethnic variability and data extrapolation. Japan's regulatory framework, guided by pharmaceuticals medical devices agency (PMDA) principles and the "Guideline for Clinical Evaluation Methods of Anticancer Drugs," emphasizes patient efficacy, safety and relevance, historically requiring local data to supplement global findings. This review analyzed the approvals of oncology drugs in Japan over 5 years, focusing on the role of Japanese subgroup data and overall survival (OS) outcomes in pivotal trials. Among 165 approvals for oncology drugs, OS in pivotal trials was set as a sole primary endpoint in 9.1% (15/165) and as co-primary/dual primary endpoints in 10.3% (17/165); alternative endpoints such as progression-free survival were accepted when OS was impractical. In 7.9% (13/165) of all approvals, Japanese subpopulation results diverged from trends of overall population (hazard ratio [HR] > 1 in Japanese subpopulation), and 4.2% (7/165) of the approvals involved trials in which the primary endpoint of OS (including a sole, co-primary or dual primary endpoint) was not achieved. The PMDA decisions reflected holistic evaluation, considering trial design integrity, secondary endpoints, and qualitative consistency rather than rigid HR thresholds. Differences in efficacy in Japanese subgroup rarely impacted labeling, underscoring reliance on global evidence with local scientific considerations. These findings highlight the PMDA's pragmatic approach to endpoint flexibility and extrapolation, reinforcing the importance of early regulatory engagement and strategic alignment in MRCT design for oncology drug development in Japan.

During the last several decades, the scientific and ethics communities have addressed important ethical issues in medical research, resulting in the elaboration and adoption of concepts, guidelines, and codes. Ethical issues in the conduct of Multiregional Clinical Trials have attracted significant attention mainly in the last two decades. With the globalization of clinical research and the rapid expansion to countries with a limited tradition of biomedical research, sponsors must proactively address local ethical issues, the adequacy of oversight as well as the applicability and validity of data, and scientific conclusions drawn from diverse patient populations. This paper highlights some core ethical principles and milestones in medical research, and, from an industry perspective, it discusses ethical issues that the clinical trial team may face when conducting Multiregional Clinical Trials (MRCT, clinical trials conducted at sites located across multiple geographic regions of the world). This paper further highlights the areas of consensus and controversies and proposes points to consider.

In order to encourage innovative medicine to address Chinese unmet medical needs, China has changed its drug regulatory landscape to speed up access to new medicines. In order to understand the fast‐changing landscape and to enable planning of more global drug development programs and study designs in China, we reviewed 15 published clinical pharmacology‐related guidances by the National Medical Products Administration (NMPA), and compared them with reference guidances from the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), or the International Conference on Harmonization (ICH), to understand the similarities and differences, especially any China‐specific requirements, such as ethnic sensitivity analysis. Overall, by reviewing these clinical pharmacology‐related NMPA guidances, it is clear that NMPA guidances are very similar to FDA, EMA, and ICH guidances. There are no relevant differences in the major principles, but some differences in structure, contents, and focus were noted. The NMPA is adapting flexibility statements into newly published guidances. Ethnic sensitivity analysis needs to be implemented early in drug development plans. The NMPA encourages sponsors to conduct early clinical trials in China or include China early in multiregional clinical trials, and to obtain safety, efficacy, and pharmacokinetic data for ethnic sensitivity analysis. Depending on the stage of development, ethnic sensitivity analysis can be conducted using in vitro or literature data, other Asian clinical data, or Chinese clinical data.

Discovering and developing new drugs/ medicines is very crucial for the pharmaceutical industry. The increasing number of drugs approved in recent years demonstrates the impact of modern drug discovery approaches, digital technologies, and automated drug development methodologies. Drug development is a systematic and methodological process of developing a new pharmaceutical drug once the process of Drug discovery has identified the prime pharmacological component. The structured sequence of steps followed for drug development aims to ensure the safety and efficacy of the drug being developed. It includes pre-clinical research on microorganisms and animals, preparation of detailed data with respect to pharmacology, pharmacokinetics and toxicology details, application and approval by regulatory authorities and conduction of clinical trials. The conduction of clinical trials is an expensive affair as it needs a collaborative effort by multiple stakeholders along with a high level of monitoring and regulation. The data generated during the lifecycle of clinical trials is very critical for pharmacological scientific publications, regulatory approval for the target drug and post-marketing surveillance that ultimately leads to the development of better decision support systems for drug development. Hence, the data integrity of such data is of prime importance. Several Clinical data management (CDM) systems have been developed to ensure seamless collection and management of clinical trial data. These CDM systems enable useful analysis and decisions supported by authentic data. However, such systems face several security challenges with respect to privacy, integrity and authenticity of the clinical data. Another major challenge in conducting the clinical trials is finding the appropriate willing candidate who is physically and clinically suitable for the study. In view of the above, it is highly desirable to have a technology component that can address the above-mentioned issues. In this chapter, the technologies like blockchain and cloud computing have been introduced to address the challenges posed by clinical trial data management. The paper also proposes a blockchain based secure clinical data management system. The proposed system intends to help the data security issues like data integrity, privacy, ease and quick access to immutable clinical trial data with thorough access control enabling greater transparency and accountability.

The degree of consistency of treatment effects seen across regions within a multiregional clinical trial has important implications for all stakeholders. It can affect the ability of the trial resu...

Tobacco use is universally recognized as the foremost preventable cause of cancer in the United States and globally and is responsible for 30% of all cancer-related deaths in the United States. Tobacco use, including exposure to secondhand smoke has been implicated as a causal or contributory agent in an ever-expanding list of cancers, including lung, oral cavity and pharynx, pancreas, liver, kidney, ureter, urinary bladder, uterine cervix, and myeloid leukemia. In addition to and independent of the etiologic effects of tobacco carcinogens in numerous cancers, there is a growing literature on the direct and indirect effects of smoking on treatment efficacy (short-term and long-term outcomes), toxicity and morbidity, quality of life (QOL), recurrence, second primary tumors (SPT), and survival time as summarized below. Oncology health professionals have called for increased advocacy for tobacco control. Despite the critical relevance of smoking to cancer outcomes, most oncology clinical trials do not collect data on smoking history and status unless the malignancy is widely acknowledged as smoking related (e.g., lung or head and neck cancer). Usually, these data are collected only at trial registration. Changes in smoking status during treatment or follow-up are monitored in very few trials and are infrequently reported in sample descriptions or included in analysis plans as a potential moderator of outcomes. Based on mounting evidence that tobacco use affects cancer treatment outcomes and survival, we recommend that smoking history and status be systematically collected as core data in all oncology clinical trials: at diagnosis, at trial registration, and throughout treatment and follow-up to long-term survival or death. We feel that the inclusion and analysis of such data in clinical trials will add important information to the interpretation of outcomes and the development of scientific knowledge in this area. Smoking status has been called another "vital sign" because of its relevance to a patient's immediate medical condition. We explain the critical value of knowing the smoking status of every patient with cancer at every visit by providing a brief overview of the following research findings: (a) the effects of tobacco use on cancer treatment and outcome; (b) recent findings on the role of nicotine in malignant processes; (c) some unexpected results concerning tobacco status, treatment, and disease outcome; and (d) identifying key questions that remain to be addressed. We provide a suggested set of items for inclusion in clinical trial data sets that also are useful in clinical practice.