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The Christie
                                         NHS Foundation Trust




“WORKING IN CLINICAL TRIALS”


                   Sukhy Thandi
(BSc Biological Science, 2000; PhD Cell Physiology, 2004)
The Christie
                                         NHS Foundation Trust
                      Present
The Christie Hospital in Manchester 2008 – present
The Christie is one of Europe's leading cancer centres,
treating over 40,000 patients a year.

Clinical Trials Coordinator
The Christie
                                              NHS Foundation Trust
                  Clinical Trials
Several different types of Clinical Trials
    - drug trials
             - medical devices
                     - surgical / physical procedure
                              - therapy

Derek Crowther Clinical Trials Unit
    - Clinical “drug trials” in cancer patients


Funding / collaborations from:
    - drug companies (industry sponsors)
            - Charities (e.g. CRUK)
                    - Department of Health
The Christie
                                                      NHS Foundation Trust

          Clinical Trials of IMPs
“drug”: Investigational Medicinal Product – IMP



Clinical Trial of an IMP – CTIMPs!



Since 2004, all trials involving medicines for human use are
required by law to meet the EU clinical trials directive

    - these regulations ensure all trials are carried out to the same standards
      wherever they take place
The Christie
                                                     NHS Foundation Trust
                    Clinical Trials
Pre-clinical studies – extensive laboratory / animal testing

Phase I – first human trial for a new drug /treatment
     (or first combination of two or more drugs / treatments)
     - examine safety, toxicity and maximum tolerated dose
            - usually few patients only (10-20)

Phase II – after safety profile ascertained from phase I, use larger
group of patients (20 -200)

Phase III – comparison with current treatments / placebo - may
involve hundreds/thousands of patients

Phase IV – Following licensing; ongoing assessment of long
term effects and benefits
The Christie
                                            NHS Foundation Trust


Human Participants in Clinical Trials
Research participants make a significant contribution to the
progress of research and knowledge



Research involving human participants must meet both high
scientific and ethical standards
     - benefits must outweigh risk of harm



Both independent Regulatory and Ethical approval is essential
The Christie
                                                       NHS Foundation Trust


Regulatory & Ethical Approval of CTIMPs
Medicines and Healthcare Products Regulatory Agency (MHRA)
    - Ensure compliance with medicines for human use regulations 2004


National Research Ethics Service (NRES)
    - Protect the dignity, rights, safety and well being of participants
              - study design
                        - informed consent
                                   - protect vulnerable persons



Trust approval from Research & Development (R&D)
    - feasibility of studies
               - adhere to GCP
The Christie
                                    NHS Foundation Trust

Role of a Clinical Trial Coordinator

                STUDY SET-UP
                FEASIBILITY?



      DATA
                                  FINANCE
   MANAGEMENT




                Clinical Trial
                Coordinator


                                    MHRA
      TRUST                      (sponsors for
     APPROVAL
                                    CTIMPs)


                 APPLYING TO
                   ETHICS
The Christie
                                   NHS Foundation Trust


           The Trail of Clinical Trials!
                                    Aug 2008
Protocol

                                    Oct 2008
MHRA

Specialised regulatory approval     Dec 2008
            - e.g. GTAC, ARSAC
                                    Jan 2009
Ethical Approval

                                    Feb 2009
Trust R&D approval

                                    Feb 2009
Initiation of site

                                    Mar 2009
Start recruiting patients!
The Christie
                                                      NHS Foundation Trust

                        Useful links
Medical Research Council (MRC)
    - clinical trials toolkit: www.ct-toolkit.ac.uk


National Research Ethics Committee (NRES): www.nres.npsa.nhs.uk


Medicines and Healthcare products Regulatory Agency (MHRA):
www.mhra.gov.uk


For Trials Info’ in Cancer Research
             - CRUK: www.cancerhelp.org.uk
                     - The Christie: www.christie.nhs.uk

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Clinical Trials

  • 1. The Christie NHS Foundation Trust “WORKING IN CLINICAL TRIALS” Sukhy Thandi (BSc Biological Science, 2000; PhD Cell Physiology, 2004)
  • 2. The Christie NHS Foundation Trust Present The Christie Hospital in Manchester 2008 – present The Christie is one of Europe's leading cancer centres, treating over 40,000 patients a year. Clinical Trials Coordinator
  • 3. The Christie NHS Foundation Trust Clinical Trials Several different types of Clinical Trials - drug trials - medical devices - surgical / physical procedure - therapy Derek Crowther Clinical Trials Unit - Clinical “drug trials” in cancer patients Funding / collaborations from: - drug companies (industry sponsors) - Charities (e.g. CRUK) - Department of Health
  • 4. The Christie NHS Foundation Trust Clinical Trials of IMPs “drug”: Investigational Medicinal Product – IMP Clinical Trial of an IMP – CTIMPs! Since 2004, all trials involving medicines for human use are required by law to meet the EU clinical trials directive - these regulations ensure all trials are carried out to the same standards wherever they take place
  • 5. The Christie NHS Foundation Trust Clinical Trials Pre-clinical studies – extensive laboratory / animal testing Phase I – first human trial for a new drug /treatment (or first combination of two or more drugs / treatments) - examine safety, toxicity and maximum tolerated dose - usually few patients only (10-20) Phase II – after safety profile ascertained from phase I, use larger group of patients (20 -200) Phase III – comparison with current treatments / placebo - may involve hundreds/thousands of patients Phase IV – Following licensing; ongoing assessment of long term effects and benefits
  • 6. The Christie NHS Foundation Trust Human Participants in Clinical Trials Research participants make a significant contribution to the progress of research and knowledge Research involving human participants must meet both high scientific and ethical standards - benefits must outweigh risk of harm Both independent Regulatory and Ethical approval is essential
  • 7. The Christie NHS Foundation Trust Regulatory & Ethical Approval of CTIMPs Medicines and Healthcare Products Regulatory Agency (MHRA) - Ensure compliance with medicines for human use regulations 2004 National Research Ethics Service (NRES) - Protect the dignity, rights, safety and well being of participants - study design - informed consent - protect vulnerable persons Trust approval from Research & Development (R&D) - feasibility of studies - adhere to GCP
  • 8. The Christie NHS Foundation Trust Role of a Clinical Trial Coordinator STUDY SET-UP FEASIBILITY? DATA FINANCE MANAGEMENT Clinical Trial Coordinator MHRA TRUST (sponsors for APPROVAL CTIMPs) APPLYING TO ETHICS
  • 9. The Christie NHS Foundation Trust The Trail of Clinical Trials! Aug 2008 Protocol Oct 2008 MHRA Specialised regulatory approval Dec 2008 - e.g. GTAC, ARSAC Jan 2009 Ethical Approval Feb 2009 Trust R&D approval Feb 2009 Initiation of site Mar 2009 Start recruiting patients!
  • 10. The Christie NHS Foundation Trust Useful links Medical Research Council (MRC) - clinical trials toolkit: www.ct-toolkit.ac.uk National Research Ethics Committee (NRES): www.nres.npsa.nhs.uk Medicines and Healthcare products Regulatory Agency (MHRA): www.mhra.gov.uk For Trials Info’ in Cancer Research - CRUK: www.cancerhelp.org.uk - The Christie: www.christie.nhs.uk