# Milestone to Ensure Safety and Efficacy of Companion Diagnostic (CDx) That Support Treatment Decisions in Cancer Patients

## TL;DR

This study examines global regulations for companion diagnostics in cancer treatment to ensure their safety and effectiveness.

## Contribution

The paper provides evidence-based regulatory checklists for CDx development and approval across different countries.

## Key findings

- Regulatory frameworks for CDx vary significantly between countries.
- Checklists were validated by industry experts for feasibility.
- The checklists support global market access and improve licensing practices.

## Abstract

As demand for biomarker-based companion diagnostics (CDx) tests in clinical oncology of precision medicine increases, a clear understanding of the regulatory framework (especially analytical and clinical performance) is imperative to ensure the safety and efficacy of CDx in enhancing patient quality of life and aiding in treatment decisions. This study analyzes the regulatory policies and approval reports in major countries and identifies regulatory checklists for the pre- and post-marketing analytical and clinical performance to ensure safety and efficacy of CDx. It categorizes the pre-marketing analysis into four commonly used techniques, IHC, FISH, PCR, and NGS, reflecting the diversity of CDx types. All analyses are grounded in the latest regulations and guidelines. The developed checklists were subjected to feasibility assessment by industry experts. Our analysis revealed that there are differences in the pre- and post-marketing regulatory frameworks for CDx, reflecting unique characteristics of each country. In particular, differences were observed in the safety and efficacy assessment methods applied to the platform based on technological principle. Evidence-based checklists are established, which support manufacturers in implementing efficient practices and creating systematic regulatory strategies. Furthermore, these checklists facilitate global market access, activate R&D, enhance clinical implementation, and improve licensing practices.