FDA Watch: Greenlights for NGS Tumor Panels May Augur New Approach to LDT Approvals—Both Product & Pathway

A pair of tumor tests highlights the list of new FDA approvals from mid-November through December, including:

• FoundationOne’s CDx (F1CDx) companion diagnostic test for solid tumors; and
• Memorial Sloan Kettering Cancer Center’s Integrated Mutation Profiling of Actionable Cancer Targets tumor profiling test assay (MSK-IMPACT).

Of course, FDA approval of next-generation sequencing-based (NGS) personalized medicine cancer assays is always a pretty big deal for the diagnostics community. But these developments may have an even deeper significance to the extent they offer clues on the agency’s wider approach to approval of laboratory-developed tests (LDTs) going forward.

The Approved Products
MSK-IMPACT is a 468-gene panel detecting genetic mutations in rare and common cancers. Data Profile: According to the agency, the data demonstrated that the assay is highly accurate (over 99%) and capable of detecting a mutation at a range of 2% to 5%. percent to 5 percent). Additionally, the test could detect microsatellite instabilities 92% of the time across multiple cancer types in 175 cases, when compared to traditional detection methods.

F1CDx can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor type. Data Profile: The FDA found that the data demonstrated the test’s ability to detect select mutation types with 94.6% accuracy. Of course, this isn’t the first companion diagnostic the agency has approved. However, rather than match one test to one drug the way all previously approved tests do, F1CDx enables matching of patients with five different tumor types to 15 different approved, targeted treatments, including those for non-small cell lung cancer, melanoma, breast cancer, colorectal cancer, or ovarian cancer.

The Approval Pathways
The story is not just that both tests were approved but also how they were approved.

MSK-IMPACT became the first comprehensive tumor-profiling LDT to receive FDA authorization through the de novo premarket review pathway. It had previously been approved by the New York State Department of Health as a laboratory-developed clinical test. The FDA authorized MSK-IMPACT as a Class II, moderate-risk device, which enables subsequent, similar types of tests to use the FDA’s less onerous 510(k) clearance pathway.

F1CDx, meanwhile, was approved by the FDA in concert with the CMS under the Parallel Review Program designed to speed up adoption of innovative technologies by allowing for tests to receive FDA approval and immediate Medicare coverage determination simultaneously. The Parallel Review Program is open to certain premarket approval applications for new device technologies that fall within Medicare’s Part A or Part B benefit categories. A final coverage decision is expected in the first quarter of 2018, at which time F1CDx will be made commercially available. Analysts say that simultaneous FDA approval and Medicare coverage could also have a positive impact on private reimbursement decisions.

Other New FDA Approvals
Meanwhile, here’s a rundown of the other key new approvals issued by the FDA in mid-November through December:

NEW FDA APPROVALS

In December, the FDA granted CLIA waivers to the following test kits:

NEW FDA CLIA WAIVERS

New CE Marks & Global Certifications
Notable European CE certifications:

NEW CE CERTIFICATIONS

Other key international clearances included World Health Organization approval of Atomo Diagnostics’ Atomo HIV Self Test, an HIV self-test that is now eligible for procurement by organizations that can access Global Fund and Unitaid resources.