The Rise of Personalized Medicine Implications for the

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The Rise of Personalized Medicine: Implications for the IVD Industry Linda D. Bentley, Esq.

The Rise of Personalized Medicine: Implications for the IVD Industry Linda D. Bentley, Esq. Mass. MEDIC Diagnostics Industry Update March 31, 2009

Personalized Medicine The use of patient-specific information to tailor products and therapies that will

Personalized Medicine The use of patient-specific information to tailor products and therapies that will increase the likelihood of a favorable outcome for that patient. Involves the use of biomarkers which may be associated with genes, proteins or metabolic pathways. Potential benefits include: • Earlier detection of disease • Information about likelihood to develop disease • Identification of therapies • Prediction of response to treatment – – – Effectiveness Appropriate dose Adverse events MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Stephen Smith. (2009, March 3). MGH to use genetics to personalize cancer care. Boston

Stephen Smith. (2009, March 3). MGH to use genetics to personalize cancer care. Boston Globe, p. A. 1. MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

In Vitro Diagnostics • Offered by clinical laboratories as testing service – CLIA (Clinical

In Vitro Diagnostics • Offered by clinical laboratories as testing service – CLIA (Clinical Laboratory Improvement Amendments of 1988) certified laboratory – Customers are physicians and other laboratories – Most not currently subject to FDA clearance or approval • Sold as test kits – Customers are other laboratories – Regulated by FDA as medical devices requiring 510(k) clearance, PMA approval or De Novo Classification • Device means an instrument, apparatus, in vitro reagent or other similar or related article intended for use in the diagnosis of disease or other condition or the cure, mitigation, treatment or prevention of disease and does not achieve primary purposes through chemical action within or on body and not metabolized. MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

FDA Regulatory Pathways • Established – 510(k) Premarket notification • Show that product is

FDA Regulatory Pathways • Established – 510(k) Premarket notification • Show that product is substantially equivalent to predicate device • Could require nonclinical and clinical studies • Some diagnostic tests used in conjunction with drug follow 510(k) route while others will require PMA – 510(k) - UGT 1 A 1 gene assay (Camptosar) but PMA for HER 2/neu (Herceptin) – Premarket Approval Application (PMA) • Generally required of IVDs with higher risk • Safe and effective for intended use, i. e. , clinical study • May involve advisory committee review – De Novo Classification • No predicate device so automatic Class III/PMA • Permits low/moderate risk device to by-pass PMA, e. g. , Mamma. Print MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Laboratory Developed Tests • Formerly known as “home brews” • FDA asserted authority, but

Laboratory Developed Tests • Formerly known as “home brews” • FDA asserted authority, but historically exercised enforcement discretion and didn’t regulate • “New” FDA interest in some of these tests – Warning letters • Who developed and validated test? – Proposed draft guidance • In Vitro Diagnostic Multivariate Index Assay (IVDMIA) – Utilizes algorithm, involves multiple markers or requires explanation of test result • CLIA – Applies to all clinical laboratories that perform diagnostic tests – Analytical validity versus clinical validity MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Potential for Change FDA • FDA’s newly appointed Senior Genomics Advisor in Office of

Potential for Change FDA • FDA’s newly appointed Senior Genomics Advisor in Office of Chief Scientist – Dr. Elizabeth Mansfield has worked in FDA’s OIVD and in industry • Critical Path Initiative - new tools for product evaluation – Biomarker assessments to correlate the presence of genes or proteins and likely response to medication – Guidance for the pharmaceutical industry on co-development of drugs and diagnostic tests. • Collaboration with NIH and other research institutions in applied research efforts to study the genetic basis of drugrelated toxicities. • Medco partnership (PBM) MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Potential for Change (cont. ) External efforts to change FDA regulatory process • Proposals

Potential for Change (cont. ) External efforts to change FDA regulatory process • Proposals in Congress to subject all IVDs to FDA review or approval • Citizen petition – Genentech (12/5/08) asked that all IVDs be actively regulated by FDA – Adva. Med (3/27/09) submitted proposal on “Risk-Based Regulation of Diagnostics” MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Potential for Change (cont. ) Others - Governmental and Private • Secretary’s Advisory Committee

Potential for Change (cont. ) Others - Governmental and Private • Secretary’s Advisory Committee on Genetics, Health and Society (SAGCHS) – Chartered in 2002 to provide advice to Secretary of HHS – Issued report May 2008 on potential of pharmacogenomics http: //oba. od. nih. gov/oba/SACGHS/reports/SACGHS_PGx_rep ort. pdf • The Personalized Medicine Coalition – A broad spectrum of academic, industry, patient, provider and payer communities seeking to advance the understanding and adoption of personalized medicine. www. personalizedmedicinecoalition. org • Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Challenges • Early Stage – Few products on market - tests not widely adopted,

Challenges • Early Stage – Few products on market - tests not widely adopted, e. g. , FDAcleared test for 2 gene variants and warfarin – Need to access accuracy and predictive value • FDA has incorporated pharmacogenetic information in some drug labeling, but clinical usefulness of most tests still unknown • Reimbursement uncertain • Current coding not conducive to innovative test development • Payers not convinced of usefulness • May not support cost of developing tests • Needs robust health information technology MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Challenges (cont. ) • Economic Incentives for co-development – Decreased market for certain drugs

Challenges (cont. ) • Economic Incentives for co-development – Decreased market for certain drugs – Faster drug approvals • FDA Guidance on genomics and drug development – More post-marketing surveillance • Education and training • Ethical, social and legal issues MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC

Linda D. Bentley, Esq. Member Mintz Levin Cohn Ferris Glovsky and Popeo, P. C.

Linda D. Bentley, Esq. Member Mintz Levin Cohn Ferris Glovsky and Popeo, P. C. One Financial Center Boston, MA 02111 ph: (617) 348 -1784 LDBentley@mintz. com www. mintz. com MINTZ LEVIN COHN FERRIS GLOVSKY AND POPEO PC