Title:Phase 1 Clinical Trials of Small Molecules: Evolution and State of the Art
Volume: 16
Issue: 3
Author(s): John J. Sramek, Michael F. Murphy, Sherilyn Adcock, Jeffrey G. Stark and Neal R. Cutler*
Affiliation:
- Worldwide Clinical Trials, 401 N Maple Dr, Beverly Hills, CA90210,United States
Keywords:
Phase 1 clinical trials, maximally tolerated dose, healthy volunteers, drug development, pharmacology, small
molecules.
Abstract:
Background: Phase 1 studies comprise the first exposure of a promising new chemical
entity in healthy volunteers or, when appropriate, in patients. To assure a solid foundation for subsequent
drug development, this first step must carefully assess the safety and tolerance of a new compound
and often provide some indication of potential effect, so that a safe dose or dose range can
be confidently selected for the initial Phase 2 efficacy study in the target patient population.
Methods: This review was based on a literature search using both Google Scholar and PubMed, dated
back to 1970, using search terms including “healthy volunteers”, “Phase 1”, and “normal volunteers”,
and also based on the authors’ own experience conducting Phase 1 clinical trials. This paper
reviews the history of Phase 1 studies of small molecules and their rapid evolution, focusing on the
critical single and multiple dose studies, their designs, methodology, use of pharmacokinetic and
pharmacodynamic modeling, application of potentially helpful biomarkers, study stopping criteria,
and novel study designs.
Results: We advocate for determining the safe dose range of a new compound by conducting careful
dose escalation in a well-staffed inpatient setting, defining the maximally tolerated dose (MTD)
by reaching the minimally intolerated dose (MID). The dose immediately below the MID is then
defined as the MTD. This is best accomplished by using appropriately screened patients for the target
indication, as patients in many CNS indications often tolerate doses differently than healthy
non-patients. Biomarkers for safety and pharmacodynamic measures can also assist in further defining
a safe and potentially effective dose range for subsequent clinical trial phases.
Conclusion: Phase 1 studies can yield critical insights into the pharmacology of a new compound
in man and offer perhaps the only development period in which the dose range can be safely and
thoroughly explored. Phase 1 studies often contain multiple endpoint objectives, the reconciliation
of which can present a dilemma for drug developers and study investigators alike, but which can
crucially determine whether a compound can survive to the next step in the drug development process.
