Overview of literature monitoring practice of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group

INTRODUCTION

The evaluation of clinical trial (CT) safety is the main task of CT vigilance units. In addition to the management of adverse events, the units must review the literature to identify information that may impact the benefit-risk assessment of studies. In this survey, we investigated the literature monitoring (LM) activity of French Institutional Vigilance Units (IVU) from the working group "REflexion sur la VIgilance et la SEcurite des essais cliniques" (REVISE).

MATERIAL AND METHODS

We sent a questionnaire of 26 questions, divided into four themes, to the 60 IVU: (1) Presentation of the IVU and the LM activity; (2) Used sources, queries and criteria for selecting articles; (3) Valuation of the LM and (4) Practical organisation.

RESULTS

Of the 27 IVU that responded to the questionnaire, 85% of them carried out LM. This was mainly provided by medical staff to improve general knowledge (83%), to detect Adverse Reactions (AR) not listed in the reference documents (70%) and to detect new safety information (61%). Due to lack of time, staff, available recommendations and sources, only 21% of IVU conducted LM for all CT. On average, units reported four sources: ANSM information (96%), PubMed database (83%), EMA alerts (57%) and the subscription to APM international (48%). The LM had an impact on the CT of 57% of the IVU such as changing the conditions of a study (39%) or suspending a study (22%).

DISCUSSION/CONCLUSION

LM is an important but time-consuming activity with heterogeneous practices. According to the results of this survey, we proposed seven ways to improve this practice: (1) Target the highest risk CT; (2) Refine the PubMed queries; (3) Use other tools; (4) Create a decision flowchart for the selection of PubMed articles; (5) Improve training; (6) Value the activity and (7) Outsource the activity.

Overview of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group

PURPOSE

To follow the European Directive 2001/20/EC, institutional sponsors created or reinforced their vigilance units. Since 2007, the working group "REflexion sur la VIgilance et la Sécurité des Essais" (REVISE) rallies French institutional vigilance units (IVUs) to share their experience. The group decided to elaborate a collective work to provide a real-life descriptive picture of French IVUs activities and resources over the 2011-2016 period.

METHOD

A questionnaire was sent to the 60 IVUs of the group. It included questions on staff and activities, such as the number of received and analyzed serious adverse events (SAEs). All results and proposals were discussed and consensus was achieved in general meeting.

RESULTS/CONCLUSION

The results highlight the commitment of IVU staffs at many steps of CTs, but also the frailty of some units, leading to 6 proposals intended to institutional sponsors and competent authorities for ensuring (1) IVU visibility to all actors; (2) sustainable IVU staff; (3) IVU resources adapted to sponsor's ambitions; (4) valorization of IVUs in publications; (5) recognition of IVU's value in clinical research quality; (6) involvement of IVUs in regulatory changes and their procedures of implementation.

Abstract P5-21-05: ERALOP study: Post adjuvant FEC - docetaxel chemotherapy for early breast cancer: Hair regrowth in the real life

Background : during 2008 we have collected one hundred observations of persistent significant alopecia (PSA). FEC 100-docetaxel 100 mg/msq regimen was mostly concerned. We therefore decided to evaluate exact incidence of this relevant side effect through women points of view.

Methods : ERALOP is a retrospective study using a self-questionnaire targeting patients (pts) treated with this sequential regimen from 2008 to 2009. The primary objective was to estimate the incidence of a PSA at 6 months after last course of docetaxel with CTCAE 4.0 classification : grade 1 : hair loss of up to 50% not obvious from a distance, a different hair style may be required to cover the hair loss, grade 2 : hair loss > 50% with a psychosocial impact. The sample size calculation of 635 patients took into account : PSA incidence of 3.2% (TAC regimen), precision of 0.015, α risk at 0.05, 20% patients lost for follow up. ERALOP study was approved by local ethic comitee.

Results: from July 2012 to October 2012, 829 pts received a self-questionnaire. 176 pts (21%) did not answer and were considered as without PSA. 653 (79%) answers with medical data fully documented were collected. Median age of patients was 56 years. Six months after last docetaxel course, PSA incidence grade 2 : 8.6% (71 pts), grade 1 : 32.6% (271 pts), grade 0 : 56% (466 pts), NA : 2.5% (21 pts). 73% of pts with PSA received hormonotherapy. At the time of the inquiry (median follow up of 3.7 years), PSA incidence grade 2 was 3.5% (29 pts), grade 1 : 30% (248 pts), grade 0 : 63,8% (529 pts), for a global PSA incidence of 33.4%. Between 6 months after last course of docetaxel and time of the inquiry, it appears slight or total regrowth for 40 pts with PSA grade 2 and 187 with PSA grade 1.Three pts still wore a wig, and many pts had suboptimal regrowth of eyelash (31%), eyebrow (47%), pubic hair (27%), and nail disorders (27%). A multivariate analysis was performed to look for PSA risk factors. All the oral treatments, including dexpanthenol, biotin, methionine cysteine and cystin-vitamin B6 proved to have no efficacy. Treatment by topical minoxidil could have a little efficacy. Impairment of health-related quality of life will be assesed by Dermatology Life Quality Index (DLQI) and alopecia grade will be evaluated at the end of hormonotherapy.

Conclusions: Physicians and patients should be aware of this new distressing side-effect. This high level of PSA lead us to conduct ALOPREV trial to investigate, in spite of FEC induced alopecia, the properties of cooling cap prevention trial during docetaxel infusion. Preliminary results are encouraging and this option could be considered.

Citation Format: Hugues Pierre Bourgeois, Aurélie Jamet, Françoise Grudé, Carole Adounkpe, Pierre Kerbrat, Remy Delva, Hélène Simon, Philippe Deguiral, Bertrand Diquet, Pascale Lainé, Anne-Lise Septans. ERALOP study: Post adjuvant FEC - docetaxel chemotherapy for early breast cancer: Hair regrowth in the real life [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-21-05.