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These therapies have broadened treatment options for patients to expand beyond the more traditional smallmolecule drug alternatives. However, ADCs are a nascent therapeutic option and real-world clinical data is emerging daily that is shedding light on the utility and potential of this exciting modality to deliver against its promise.
The emergence and adoption of clinically relevant biomarkers is gradually presenting alternatives to MTD, particularly around therapies such as cell and gene therapy (CGT) and immunotherapy. ClinicalPharmacology and Therapeutics. ClinicalPharmacology and Therapeutics. Rodrigues AD. 113:9861002.
Additionally, this approach is generally no longer applicable to new treatments that are more targeted in their effects, such as immunotherapies and targeted smallmolecule therapies. This has spawned a movement focused on optimizing dose selection in oncology drug development.
In 2015, the FDA, along with the American Association for Cancer Research (AACR), held a workshop on dose optimization for smallmolecules. Progression-free survival (PFS) has been used for accelerated approval, traditional approval, and for measuring direct clinical benefits in certain circumstances. [
For example, these products face a much more arduous path for development of biosimilar or interchangeable products than that of generics for smallmolecules.
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