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J Natl Cancer Inst. 2019 Aug 27. pii: djz167. doi: 10.1093/jnci/djz167. [Epub ahead of print]

Master protocol trial design for efficient and rational evaluation of novel therapeutic oncology devices.

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Harvard Radiation Oncology Program, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.


Historically, the gold standard for evaluation of cancer therapeutics, including medical devices, has been the randomized clinical trial. Although high quality clinical data are essential for safe and judicious use of therapeutic oncology devices, class II devices require only pre-clinical data for United States Food and Drug Administration approval and are often not rigorously evaluated prior to widespread uptake. Herein, we review master protocol design in medical oncology and its application to therapeutic oncology devices, using examples from radiation oncology. Unique challenges of clinical testing of radiation oncology devices (ROD) include patient and treatment heterogeneity, lack of funding for trials by industry and healthcare payors, and operator dependence. To address these challenges, we propose the use of master protocols to optimize regulatory, financial, administrative, quality assurance, and statistical efficiency of trials evaluating ROD. These device-specific master protocols can be extrapolated to other devices, and encompass multiple sub-studies with the same design, statistical considerations, logistics, and infrastructure. As a practical example, we outline our Phase I/II master protocol trial of stereotactic magnetic resonance imaging-guided adaptive radiotherapy (SMART), which to the best of our knowledge is the first master protocol trial to test a ROD. Development of more efficient clinical trials is needed to promote thorough evaluation of therapeutic oncology devices, including ROD, in a resource-limited environment, allowing more practical and rapid identification of the most valuable advances in our field.


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