Steps and time to process clinical trials at the Cancer Therapy Evaluation Program

Abstract

Purpose: To examine the processes and document the calendar time required for the National Cancer Institute's Cancer Therapy Evaluation Program (CTEP) and Central Institutional Review Board (CIRB) to evaluate and approve phase III clinical trials.

Methods: Process steps were documented by (1) interviewing CTEP and CIRB staff regarding the steps required to activate a trial from initial concept submission to trial activation by a cooperative group, (2) reviewing standard operating procedures, and (3) inspecting trial records and documents for selected trials to identify any additional steps. Calendar time was collected from initial concept submission to activation using retrospective data from the CTEP Protocol and Information Office.

Results: At least 296 distinct processes are required for phase III trial activation: at least 239 working steps, 52 major decision points, 20 processing loops, and 11 stopping points. Of the 195 trials activated during the January 1, 2000, to December 31, 2007, study period, a sample of 167 (85.6%) was used for gathering timing data. Median calendar days from initial formal concept submission to CTEP to trial activation by a cooperative group was 602 days (interquartile range, 454 to 861 days). This time has not significantly changed over the past 8 years. There is a high variation in the time required to activate a clinical trial.

Conclusion: Because of their complexity, the overall development time for phase III clinical trials is lengthy, process laden, and highly variable. To streamline the process, a solution must be sought that includes all parties involved in developing trials.

Fig 1.

Level 0 process flow map for activating a phase III trial through Cancer Therapy Evaluation Program and Central Institutional Review Board.

Fig 2.

A detail process flow of initial concept submission illustrating a process loop and a stopping point.

Fig 3.

Number of Cancer Therapy Evaluation Program (CTEP) –sponsored phase III therapeutic oncology clinical trials activated from January 2000 to December 2007 organized by development time. Development time is calculated in calendar days from the initial receipt of the concept by CTEP to the time the trial is activated by the Clinical Trials Cooperative Group.

Fig 4.

Development time (in calendar days) for a phase III trial, Cancer Therapy Evaluation Program concept receipt to activation. Box ranges (H-Spread) indicate lower 25th and upper 75th percentile of the sample. T-bars indicate the 95% CIs by year. Dots indicate trial development time outside the bounds of the CI. Year indicates the year that the trial was activated.