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Clinical Trials > Expanded Access (Compassionate Use)

Last update: 06/13/2016

TOPICS
Filing an Application for Compassionate Use | Commentary on Expanded Access 
Also see Canadian Access Program | FDA background on Expanded Access

Expanded Access (Compassionate Use) of Investigational Therapies
for patients not eligible for trials

Expanded access trials for Lymphoma or CLL

2016:  Statement from FDA Commissioner Robert Califf, M.D.
on release of final individual patient expanded access form

Overview - How it works 

Expanded Access for an Individual Patient

FDA may permit expanded access to an investigational new drug outside of a clinical investigation, or to an approved drug where availability is limited by a REMS, for an individual patient when the applicable criteria in § 312.305(a) (which apply to all types of expanded access) and § 312.310(a) (which apply specifically to individual patient expanded access, including for emergency use) are met.

Under the applicable criteria in § 312.305(a), FDA must determine that:

• The patient to be treated has a serious or immediately life-threatening disease or condition, and there is no comparable or satisfactory alternative therapy to diagnose, monitor, or treat the disease or condition;

• The potential patient benefit justifies the potential risks of the treatment use and those potential risks are not unreasonable in the context of the disease or condition to be treated; and

• Providing the investigational drug for the requested use will not interfere with the initiation, conduct, or completion of clinical investigations that could support marketing approval of the expanded access use or otherwise compromise the potential development of the expanded access use.

Under the applicable criteria in § 312.310(a):

• The patient’s physician must determine that the probable risk to the person from the investigational drug is not greater than the probable risk from the disease or condition; and

FDA must determine that the patient cannot obtain the investigational drug under another IND or protocol.

Source: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM432717.pdf


FDA Q&A 2016: PDF

 

================
 

* FDA video on Expanded Access, 2014: YouTube

  1. The requested treatment protocol must be considered reasonable by your oncologist and you must be ineligible or unable to participate in a clinical trial that is testing the protocol. 

    The protocol must be deemed reasonable for your treatment circumstance, relative to available treatment options.  

    NOTE: Safety issues are not always published and available to the patient or the doctor, leading to unrealistic expectations.  Efficacy can be overstated in early reports.)
     

  2. Your doctor must then contact the sponsor of the investigational agent, who must agree to provide the drug - they may not be able or willing. 
     
    This step can be a significant obstacle.  The drug sponsor has little to gain and possible liabilities (financial, insurance, legal) when providing investigational drugs outside the structure and close supervision of a clinical trial. 

    "When a physician would like to request an Investigational New Drug (IND) application to use an unapproved drug or other product for a single patient, the first step is to obtain permission from the manufacturer.

    Without the consent of the manufacturer, the unapproved product will not be available to the patient. After the manufacturer agrees to provide the product, the recommended procedure is to submit the following information to the appropriate review division. ... "  
    FDA.gov  

  3. Your doctor completes forms for FDA review & consent as described in the checklist below. The FDA will probably not stand in the way if the requested protocol is reasonable, relative to other available treatment options. 

    The rate limiting circumstance might depend on how your doctor communicates the urgency. 
     

  4. Finally, your doctor must obtain IRB (Institutional Review Board) approval and draw up a consent form. This step is easier if your doctor is also a clinical investigator and is familiar with the process.
     

  5. Your doctor will be responsible for monitoring, and reporting and oversight.  Cost to physician might not be compensated.  Doctor might have to assume some liability.

Compassionate Use Checklist

x
Manufacturer has committed to supplying the investigational drug
x
Letter of authorization from manufacturer included or submitted separately
x
Form FDA 1571 completed and signed (Investigational New Drug Application IND)  PDF 
x
Form FDA 1572 completed and signed (Statement of Investigator) PDF 
 
 for forms 1571 & 1572 (above)
x
CV (first two pages) including documentation of medical licensure Informed consent form completed and signed
x
Commitment to Institutional Review Board (IRB) approval prior to initiating administration of the investigational drug
x
Narrative: Medical history, disease history, prior treatments, response Patient's current medical status
x
Patient or physician's prior experience with the investigational treatment to be administered (if any), rationale for administration of the investigational drug. Proposal for treatment of the patient, including plan for concomitant treatments, administration of the investigational drug, and monitoring of the patient.

 

In the News

bullet
In the Pipeline 2013:
Compassionate Access: No Good Answer http://bit.ly/HyNRx0
bullet
CNN 2013:
In cancer drug battle, both sides appeal to ethics http://bit.ly/18yrS2I  
bullet
Oct 2009: FDA Final rule for Expanded Access (PDF - 603KB) 
AND Charging for Investigational Drugs (PDF - 394KB)
 
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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