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Review of the Fialuridine (FIAU) Clinical Trials (1995)
Institute of Medicine (IOM)

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. "Appendix F: FIAC and FIAU Preclinical Toxicity Studies." Review of the Fialuridine (FIAU) Clinical Trials. Washington, DC: The National Academies Press, 1995.

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Review of the Fialuridine (FIAU) Clinical Trials

an extended post-treatment period. It is noteworthy, however, that while mild excursions in serum alanine or aspartate aminotransferase activity were observed in some studies, no corresponding morphologic hepatic changes were reported. Furthermore, no mention of pancreatic changes are noted in the reports.

The preclinical toxicity data available prior to the PPPC clinical trial was judged to be adequate by the Food and Drug Administration, and, therefore, the clinical trial could proceed as planned. A retrospective evaluation of the material available in 1993 still supports this position. The acute and multiple dose studies performed in different laboratory animals (mice, rats, dogs, and monkeys), a chronic study in one species (mice), a battery of mutagenicity studies, and studies on reproduction yielded patterns of observations that were more or less consistent with the biologic characteristics of FIAU. Furthermore, dose-dependent relationships were generally clear, and the toxic effects usually occurred at dosages near the maximum tolerated range in each species. There was nothing in the preclinical toxicity studies that was suggestive of the tragic episode that transpired in the PPPC clinical trial. Furthermore, unfortunately, there is nothing to indicate that other laboratory animal studies would have been more appropriate or capable of better prediction of the fatal outcome.

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Front Matter (R1-R10)
Executive Summary (1-15)
Introduction (16-19)
Clinical Trials (20-33)
Hepatitis B and Other Viral Diseases (34-41)
Clinical Trials of FIAC at Memorial Sloan-Kettering Cancer Center (42-50)
Oclassen Clinical Trial R89-001-01 (51-54)
Oclassen Clinical Trial R90-001-01 (NIH Protocol 91-AI-0031) (55-60)
Oclassen Clinical Trial R91-001-10 (NIH Protocol 91-DK-AI-213) (61-65)
Eli Lilly Trial H3X-MC-PPPA (66-69)
Eli Lilly Trial H3X-MC-PPPG (70-72)
Eli Lilly Trial H3X-MC-PPPC (NIH Protocol 93-DK-0031) (73-89)
Summary of Patient Interviews (90-92)
Overall Assessment of the Trials (93-97)
Recent Studies of FIAU Toxicity (98-103)
Review of the FDA Task Force Report 'Fialuridine: Hepatic and Pancreatic Toxicity' (104-120)
Review of 'Report to the Advisory Committee to the Director, National Institutes of Health' (121-132)
FDA-Proposed Changes to the Code of Federal Regulations (133-142)
Ancillary Issues Raised During the Period Following The H3X-MC-PPPC Trial (143-149)
Conclusions and Recommendations (150-154)
Appendix A: Chronology of FIAU/FIAC Clinical Trials (155-164)
Appendix B: Bibliography and References (165-177)
Appendix C: Agendas from the Three Committee Meetings (178-183)
Appendix D: Informed Consent Documents (184-243)
Appendix E: Example of Oclassen Fax Data Summaries (244-245)
Appendix F: FIAC and FIAU Preclinical Toxicity Studies (246-250)
Appendix G: Patient Summaries, Lilly Trial H3X-MC-PPPA (251-255)
Appendix H: Statistical Analysis of Mortality in the FIAU/FIAC Clinical Trials (256-265)
Glossary (266-269)