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What is ACES®
and Where it’s Being Used
For	
   both	
   tradi+onal	
   and	
   adap+ve	
   trials,	
   ACES	
   addresses	
   the	
   secure	
   communica+on	
  
complexi+es	
  and	
  regulatory	
  concerns	
  with	
  interim	
  analysis.	
  
	
  
Since	
  introduced	
  in	
  2010,	
  we’ve	
  deployed	
  the	
  web-­‐based	
  system	
  in	
  Phase	
  2	
  and	
  Phase	
  3	
  
adap+ve	
  and	
  tradi+onal	
  trials	
  across	
  a	
  variety	
  of	
  therapeu+c	
  areas	
  including	
  oncology,	
  
CNS,	
  infec+ous	
  diseases,	
  immunology,	
  and	
  psychiatry/psychology.	
  
Access	
  Control	
  Execu/on	
  System	
  
Independent	
   expert	
   commiJees	
   –	
   Data	
  
Monitoring	
  and	
  Endpoint	
  Adjudica+on	
  –	
  while	
  
increasingly	
   important,	
   add	
   administra+ve	
  
complexity	
  for	
  clinical	
  trial	
  sponsors.	
  	
  Securely	
  
managing	
   the	
   exchange	
   of	
   confiden+al	
  
informa+on	
   for	
   these	
   commiJees	
   also	
  
exposes	
   sponsors	
   to	
   the	
   great	
   risk	
   of	
  
compromising	
  the	
  integrity	
  of	
  their	
  study.	
  
Why Sponsors are Implementing ACES
Key Benefits
1.	
  Regulatory	
  Trust	
  and	
  Confidence	
  
ACES®	
  is	
  foremost	
  designed	
  to	
  achieve	
  regulatory	
  trust.	
  	
  It	
  conforms	
  with	
  the	
  FDA	
  Guidance	
  
and	
  EMA	
  posi+on	
  on	
  DMCs	
  and	
  Adap+ve	
  Trial	
  Design	
  providing	
  evidence	
  that	
  a	
  trial	
  is	
  
conducted	
  with	
  a	
  secure	
  process,	
  including	
  a	
  ‘who	
  saw	
  what	
  and	
  when’	
  audit	
  trail.	
  
	
  
2.	
  Streamlined	
  Workflow	
  
ACES	
  is	
  purpose-­‐built	
  to	
  comprehensively	
  manage	
  clinical	
  trials	
  and	
  interim	
  analyses,	
  including	
  
the	
  documenta+on	
  and	
  firewalls	
  necessary	
  to	
  preserve	
  trial	
  integrity.	
  
	
  
ACES	
  automates	
  many	
  tasks	
  –	
  like	
  DMC	
  no+fica+ons,	
  reports,	
  or	
  randomiza+on	
  and	
  treatment	
  
updates	
  for	
  IWRS	
  and	
  drug	
  supply.	
  It’s	
  web-­‐based	
  and	
  easily	
  deployed	
  in	
  any	
  seXng.	
  
	
  
3.	
  Decision	
  Engine	
  Integra/on	
  
It’s	
  what	
  sets	
  ACES	
  apart	
  from	
  ordinary	
  document	
  management	
  packages	
  like	
  Documentum	
  
and	
  SharePoint-­‐based	
  apps.	
  	
  ACES	
  ability	
  to	
  integrate	
  these	
  engines	
  is	
  helping	
  sponsors	
  of	
  all	
  
sizes	
  make	
  even	
  their	
  most	
  complex	
  trials	
  more	
  rou+ne.	
  
	
  
Typical	
  Decision	
  Engines	
  can	
  involve	
  dose	
  selec+on,	
  randomiza+on	
  schemes,	
  drug	
  supply	
  
triggers,	
  early	
  stopping	
  rules,	
  adap+ve	
  design	
  simula+ons,	
  and	
  condi+onal	
  power	
  calcula+ons.	
  
The	
  results	
  are	
  reported	
  as	
  specified	
  in	
  the	
  protocol,	
  and	
  only	
  to	
  those	
  permiJed.	
  
Case Study - ACES Deployed in a Seamless
Phase 2 / 3 Adaptive Trial
The	
  Trial	
  Design	
  and	
  ACES	
  
Ini+ally,	
  randomize	
  subjects	
  equally	
  across	
  
four	
  treatment	
  arms,	
  then	
  perform	
  interim	
  
analysis	
  once	
  enrollment	
  reaches	
  about	
  100	
  
subjects	
  in	
  each	
  arm.	
  
	
  
The	
  trial’s	
  interim	
  analysis	
  decision	
  rules:	
  
1.  Early	
  termina+on	
  for	
  fu+lity	
  
2.  Dose	
  selec+on:	
  select	
  one	
  or	
  two	
  most	
  
ac+ve	
  doses	
  (observed	
  paJerns	
  of	
  
response	
  rates)	
  with	
  placebo	
  to	
  move	
  
into	
  trial’s	
  2nd	
  stage	
  
3.  Sample	
  size	
  increase:	
  a	
  one-­‐+me	
  
increase	
  based	
  on	
  condi+onal	
  	
  
power	
  for	
  2nd	
  stage	
  
	
  
The	
  dose	
  selec+on	
  rules	
  were	
  also	
  loaded	
  
into	
  ACES,	
  together	
  with	
  the	
  randomiza+on	
  
table	
  and	
  treatment	
  codes.	
  
Secure Reports and Communications
Between Sponsor – DMC – ISC – Site
ACES	
  Supports	
  DMC	
  
The	
  trial’s	
  DMC	
  reviewed	
  the	
  analysis	
  
report,	
  suppor+ng	
  tables,	
  lis+ngs,	
  and	
  
graphs,	
  provided	
  with	
  ACES	
  and	
  made	
  
their	
  recommenda+on	
  to	
  the	
  sponsor.	
  	
  	
  
ACES	
  securely	
  stored	
  the	
  
recommenda+on	
  and	
  triggered	
  
no+fica+on	
  to	
  the	
  sponsor	
  company	
  
representa+ves	
  to	
  review	
  and	
  accept.	
  
The	
  pivotal	
  VALOR	
  trial	
  valortrial.com	
  	
  	
  	
  	
  	
  
is	
  an	
  example	
  of	
  ACES	
  use	
  to	
  support	
  a	
  
sample-­‐size	
  re-­‐es+ma+on	
  confirmatory	
  
study	
  in	
  oncology.	
  
ACES Use Documented at ASCO
Protecting the Integrity of Adaptive Designs
(Per	
  the)	
  Guidance	
  documents	
  by	
  FDA	
  and	
  EMA	
  for	
  DSMB	
  and	
  Adap>ve	
  Trial	
  
Design,	
  sugges>ng	
  ‘A	
  well-­‐trusted	
  firewall	
  established	
  for	
  trial	
  conduct	
  ...	
  	
  
can	
  help	
  provide	
  assurance	
  that	
  sta>s>cal	
  and	
  opera>onal	
  biases	
  have	
  not	
  
been	
  introduced.’	
  	
  
Cytel’s	
  Cyrus	
  Mehta	
  and	
  Eric	
  Silva	
  with	
  Sunesis	
  Pharmaceu+cals	
  co-­‐authors	
  
From	
  their	
  accepted	
  ASCO	
  2012	
  poster	
  presenta+on	
  

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ACES - What is ACES And Who is Using It

  • 1. What is ACES® and Where it’s Being Used For   both   tradi+onal   and   adap+ve   trials,   ACES   addresses   the   secure   communica+on   complexi+es  and  regulatory  concerns  with  interim  analysis.     Since  introduced  in  2010,  we’ve  deployed  the  web-­‐based  system  in  Phase  2  and  Phase  3   adap+ve  and  tradi+onal  trials  across  a  variety  of  therapeu+c  areas  including  oncology,   CNS,  infec+ous  diseases,  immunology,  and  psychiatry/psychology.   Access  Control  Execu/on  System   Independent   expert   commiJees   –   Data   Monitoring  and  Endpoint  Adjudica+on  –  while   increasingly   important,   add   administra+ve   complexity  for  clinical  trial  sponsors.    Securely   managing   the   exchange   of   confiden+al   informa+on   for   these   commiJees   also   exposes   sponsors   to   the   great   risk   of   compromising  the  integrity  of  their  study.  
  • 2. Why Sponsors are Implementing ACES Key Benefits 1.  Regulatory  Trust  and  Confidence   ACES®  is  foremost  designed  to  achieve  regulatory  trust.    It  conforms  with  the  FDA  Guidance   and  EMA  posi+on  on  DMCs  and  Adap+ve  Trial  Design  providing  evidence  that  a  trial  is   conducted  with  a  secure  process,  including  a  ‘who  saw  what  and  when’  audit  trail.     2.  Streamlined  Workflow   ACES  is  purpose-­‐built  to  comprehensively  manage  clinical  trials  and  interim  analyses,  including   the  documenta+on  and  firewalls  necessary  to  preserve  trial  integrity.     ACES  automates  many  tasks  –  like  DMC  no+fica+ons,  reports,  or  randomiza+on  and  treatment   updates  for  IWRS  and  drug  supply.  It’s  web-­‐based  and  easily  deployed  in  any  seXng.     3.  Decision  Engine  Integra/on   It’s  what  sets  ACES  apart  from  ordinary  document  management  packages  like  Documentum   and  SharePoint-­‐based  apps.    ACES  ability  to  integrate  these  engines  is  helping  sponsors  of  all   sizes  make  even  their  most  complex  trials  more  rou+ne.     Typical  Decision  Engines  can  involve  dose  selec+on,  randomiza+on  schemes,  drug  supply   triggers,  early  stopping  rules,  adap+ve  design  simula+ons,  and  condi+onal  power  calcula+ons.   The  results  are  reported  as  specified  in  the  protocol,  and  only  to  those  permiJed.  
  • 3. Case Study - ACES Deployed in a Seamless Phase 2 / 3 Adaptive Trial The  Trial  Design  and  ACES   Ini+ally,  randomize  subjects  equally  across   four  treatment  arms,  then  perform  interim   analysis  once  enrollment  reaches  about  100   subjects  in  each  arm.     The  trial’s  interim  analysis  decision  rules:   1.  Early  termina+on  for  fu+lity   2.  Dose  selec+on:  select  one  or  two  most   ac+ve  doses  (observed  paJerns  of   response  rates)  with  placebo  to  move   into  trial’s  2nd  stage   3.  Sample  size  increase:  a  one-­‐+me   increase  based  on  condi+onal     power  for  2nd  stage     The  dose  selec+on  rules  were  also  loaded   into  ACES,  together  with  the  randomiza+on   table  and  treatment  codes.  
  • 4. Secure Reports and Communications Between Sponsor – DMC – ISC – Site ACES  Supports  DMC   The  trial’s  DMC  reviewed  the  analysis   report,  suppor+ng  tables,  lis+ngs,  and   graphs,  provided  with  ACES  and  made   their  recommenda+on  to  the  sponsor.       ACES  securely  stored  the   recommenda+on  and  triggered   no+fica+on  to  the  sponsor  company   representa+ves  to  review  and  accept.   The  pivotal  VALOR  trial  valortrial.com             is  an  example  of  ACES  use  to  support  a   sample-­‐size  re-­‐es+ma+on  confirmatory   study  in  oncology.  
  • 5. ACES Use Documented at ASCO Protecting the Integrity of Adaptive Designs (Per  the)  Guidance  documents  by  FDA  and  EMA  for  DSMB  and  Adap>ve  Trial   Design,  sugges>ng  ‘A  well-­‐trusted  firewall  established  for  trial  conduct  ...     can  help  provide  assurance  that  sta>s>cal  and  opera>onal  biases  have  not   been  introduced.’     Cytel’s  Cyrus  Mehta  and  Eric  Silva  with  Sunesis  Pharmaceu+cals  co-­‐authors   From  their  accepted  ASCO  2012  poster  presenta+on