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  1. Oncology Center of Excellence

OCE Rare Cancers Program

Promoting development of new drug and biological products to treat patients with rare cancers

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OCE Rare Cancer

The mission of the Oncology Center of Excellence (OCE) Rare Cancers Program is to promote the development of safe and effective new drugs and biologics to treat patients with rare cancers. To achieve this goal, we leverage multiple OCE projects and initiatives to address the challenges of developing new treatments for cancers that affect a small number of patients. An important aspect of our work is engagement with multiple stakeholders both inside and outside of FDA to identify opportunities to decrease obstacles, better harness scientific knowledge, and strengthen coordination to facilitate efficient drug development.

Given that rare cancers comprise a multitude of cancer types affecting a heterogenous array of patient populations, OCE recognizes that a unidimensional, one-size-fits-all approach is not sufficient to achieve this mission. Instead, OCE uses the following  programs to develop a context-specific approach that is tailored to the unique patient needs and aspects of each rare cancer:

Frequently Asked Questions

What is a rare cancer?

Although there is no universally accepted definition for a rare cancer, the Orphan Drug Act defines a rare disease or condition as one which affects less than 200,000 people in the United States (U.S). The National Institute of Health defines rare cancers as those that affect fewer than 40,000 people in the U.S., and many cancer types are even rarer. Additionally, there are also rare subsets of some more common cancers, such as lung cancer or breast cancer. These subsets can be defined based upon molecular subtype (such as ROS-1 positive lung cancer) or in some cases, on unique demographic characteristics of patients affected by the cancer (such as breast cancer in men or pediatric melanoma).

What are some of the challenges to developing drugs to treat rare cancers?

Although the challenges to rare cancer drug development vary and may not be unique to rare cancers, they can include one or more of the following:

  • Difficulty enrolling sufficient number of patients to clinical trials
  • Decreased financial incentives for drug development
  • Insufficient understanding of the cancer pathophysiology, molecular characteristics, and natural history
  • Limited or lack of timely access to molecular testing to determine eligibility for treatment with targeted therapies
  • Difficulty conducting randomized trials, due to small patient numbers or lack of appropriate therapy to use as a comparator.

How does OCE work to address challenges to developing drugs to treat rare cancers?

The OCE works in conjunction with the Office of Oncologic Diseases to proactively address the challenges that are common to rare cancer drug development as a whole and those that are specific to each rare cancer type. A few examples are provided below.

  • Representation in oncology clinical trials that is reflective of the distribution of demographic characteristics in the U.S. will help ensure the generalizability of the trial results to the U.S. population and U.S. medical practice; i.e., drugs are safe and effective for the U.S. population.
  • The Pediatric Oncology Program issues Pediatric Written Requests to incentivize development of drugs for pediatric cancers and works with stakeholders in the pediatric community to facilitate drug development.
  • The OCE Scientific Collaborative supports research to enhance knowledge of the pathophysiology of rare cancers and development of preclinical models of rare cancers to support drug development.
  • Oncology RWE Program works with OOD review divisions to provide advice regarding use of real-world data and real-world evidence to facilitate drug development; particularly relevant when considering strategies for evidence generation in rare populations.
  • Project Significant explores use of Bayesian and other statistical methodologies to demonstrate effectiveness of drugs in trials with small patient numbers.

The OCE also works closely with other FDA offices such as the Office of Orphan Product Development and the Division of Rare Diseases and Medical Genetics, other international regulatory agencies, and external stakeholders to expedite drug development for rare cancers. 

For questions or more information contact: 

OCE-RareCancerProgram@fda.hhs.gov

This program is part of the OCE Scientific Collaborative. Click here for more information. 

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