RE: MTD paradigm is no longer acceptable11 Sep 2022 18:23
Hmm….not too sure about this myself.. Optimus seems to be targeting drugs that might be taken for years (like ADC’s) where toxicity over that period cannot be properly assessed in P1 trials. Hence why the FDA are focussing on the optimal dose balancing efficacy with Safety/tolerability, rather than just MTD. AVA6000 is not, as as I understand, intended to be given for prolonged periods - it is simply a better targeting method for dox, still to be given over a relatively short period.
All that said, I have wondered if the AVCT move from targeting MTD to a “recommended” dose for the DE phase had more to do with Optimus, to find a dose balancing efficacy with safety and data, rather than just an inability to ratchet the dose to a level until we reached DLT.