Real-world data (RWD) and real-world evidence (RWE) are increasingly incorporated into regulatory decision-making to complement randomized controlled trials (RCTs), particularly in settings where conventional trial designs are infeasible, such as rare diseases, rare molecular subtypes, and post-marketing evaluation. Across regulatory authorities, the use of RWD/RWE is consistently framed by the fit-for-purpose principle, centered on two foundational concepts: relevance and reliability. However, the absence of operational guidance has created uncertainty regarding how academic registries and healthcare databases can be designed or upgraded to meet regulatory expectations. Drawing on practical experience with disease registries in Japan and their regulatory applications, this review proposes a purpose-oriented framework clarifying the levels of relevance and reliability required according to specific regulatory objectives. We categorize considerations into three use cases: (1) drug development for rare diseases and rare molecular subtypes; (2) Pharmacovigilance; and (3) evidence generation for clinical questions that cannot be sufficiently evaluated through randomized controlled trials (RCTs). For each category, we outline essential requirements related to study design, data elements, quality management, governance, statistical planning, and operational feasibility. We further compare regulatory expectations across the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), the Pharmaceuticals and Medical Devices Agency (PMDA), and the International Council for Harmonisation (ICH). While international convergence is evident at the level of principles, operational thresholds and implementation frameworks differ. By articulating relevance and reliability as a shared regulatory language and emphasizing purpose-driven design and early regulatory engagement, this review provides practical recommendations for generating regulatory-grade RWE that meaningfully informs regulatory decision-making while complementing conventional clinical trials.
Yasutoshi Sakamoto, H. Bando, Yoshihiro Aoyagi et al.· International Journal of Cli...· 0 citations
Metastatic disease remains the leading cause of cancer-related death, yet most precision oncology strategies still emphasize profiling primary tumors and tracking cell-free tumor DNA (ctDNA). Although ctDNA has transformed genomic profiling, molecular residual disease monitoring, and early cancer detection, it cannot directly capture viable tumor cell states, phenotypic plasticity, or functional adaptations that drive metastatic spread. We propose that the next phase of precision oncology should integrate the cellular dimension of metastasis through systematic circulating tumor cell (CTC) profiling. The SCRUM-MONSTAR platform, one of the largest pan-cancer molecular profiling initiatives in Japan, offers an exceptional foundation for this transition through its nationwide infrastructure for multi-omics analysis, longitudinal biospecimen collection, and artificial intelligence-enabled clinical interpretation. By combining matched tissue profiling, serial ctDNA analysis, single-cell CTC transcriptomics, metabolomics, and organoid- and mouse-based functional modeling, SCRUM-MONSTAR-CTC could evolve into a translational ecosystem for anti-metastatic drug discovery. Within this framework, we highlight adherent-to-suspension transition (AST) as one representative, experimentally tractable plasticity program that enables tumor cells to survive in circulation and subsequently colonize distant organs. We envision that identifying and therapeutically targeting AST-related and other metastatic plasticity programs across tumor types will provide a path toward clinically actionable anti-metastatic therapies. More broadly, this framework could enable the identification of metastatic vulnerabilities, the development of biomarker-guided anti-metastatic trials, and the reverse translation of patient-derived discoveries into early-phase clinical testing. Precision oncology must move beyond cataloging tumor genomes and begin targeting metastasis as a dynamic biological process. UMIN000056873, approved by the Institutional Review Board of the National Cancer Center Hospital East.
T. Hashimoto, T. Shibuki, T. Fujisawa et al.· International Journal of Cli...· 0 citations
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