No incentive to repurpose cheap drugs

Offer a large cash prize to whoever proves, in a rigorous trial, that a cheap existing drug helps people with cancer live longer. Prizes pull effort towards neglected problems.

A Japanese trial found vitamin D supplements did not help everyone after digestive cancer surgery, but appeared to help a subgroup identified by a tumour marker. That subgroup deserves its own trial.

A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.

Instead of letting a company charge more for a newly proven use of an old drug, payers would pay a one-off reward and keep the price low for everyone.

Cheap generic versions of targeted cancer drugs like imatinib exist, but patients with rare tumours carrying the matching mutation often cannot get them. A structured programme would treat them and collect the evidence.

Sometimes a progression biopsy shows exactly which drug would help, but it is licensed for another cancer and cannot be obtained. A standing pathway would fix that.

Guidelines usually wait for a drug to be licensed for a use before recommending it. For old drugs no one will license, guidelines should act directly on trial evidence.

Someone must legally own a drug's licence to update its label and monitor safety. A non-profit could do this for old drugs proven to work in cancer that no company wants.

Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.

People with cirrhosis have a high risk of liver cancer, and those who happen to take statins seem to get it less often. A proper trial would settle whether statins should be prescribed for prevention.

Cheap old drugs such as aspirin, statins, metformin and beta-blockers show hints of cancer benefit but no company will pay for the trials. Create a public fund and a way to update their labels.

Old drugs like aspirin, statins and beta-blockers show hints of fighting cancer, but no company will pay to prove it. A dedicated public fund should.

The UK's RECOVERY trial tested many cheap COVID drugs quickly by randomising thousands of ordinary hospital patients. Cancer needs the same machine for old drugs.

Create a way for a charity or university to get a cheap old drug officially approved for a new cancer use, with a few years of protection on that use so trial costs can be recovered without high prices.

If a cheap old drug could replace or reduce an expensive cancer treatment, health systems save money. Investors could fund the trial and be repaid from those savings if it works.

Cancer patients have had treatments delayed because basic chemotherapy drugs ran out. Keeping a national stockpile, like for flu antivirals, would prevent this.

Doctors often use cancer drugs outside their approved use based on a hunch or a small study. Record what happens every time so the hunches become evidence.

Large adjuvant trials already follow thousands of patients for years. Adding a second randomisation to a cheap old drug would answer repurposing questions almost for free.

Millions of people take common drugs and some get cancer. Running standardised analyses across whole-country records could rank which old drugs deserve a real trial.

An old part of the immune system called complement can be hijacked by tumours to summon protective cells. Drugs that block it already exist for other diseases.

Sleeping cancer cells survive by recycling their own contents. An old malaria drug blocks that recycling and is being tested in people with no visible cancer but detectable residual cells.

The stress of an operation may help stray cancer cells survive and settle. A few days of two cheap old drugs around surgery might reduce that risk.

An Indian trial found a cheap antipsychotic pill in very low dose improved appetite and weight gain in patients with advanced stomach, lung and pancreatic cancer. It needs confirming and adopting worldwide.

One large trial can test aspirin, a statin, metformin and exercise at the same time by randomising each separately, answering four questions for the price of one.

The evidence for old drugs against cancer is scattered across hundreds of papers. Assembling it into the format regulators and funders need is cheap and would speed decisions.

A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately.

Only the manufacturer can ask regulators to add a new use to a drug's label, and generic makers have no reason to. Universities and charities should be allowed to apply.

A cheap blood pressure drug may soften the dense scar tissue around pancreatic tumours so chemotherapy and immune cells can get in. Early trials look encouraging.

A cheap, old antipsychotic at a low dose is one of the best anti-sickness drugs for chemotherapy. Make sure every cancer unit in the world uses it.

Preparing a regulatory filing requires expensive specialist software and consultants. Free, open tools would let universities and small generic firms file in more countries.

Fund trials of old, cheap drugs with anti-cancer signals without seeking patents, and have generic makers produce them, so cost, not profit, decides whether patients get them.

Even when a trial proves a cheap old drug helps, insurers may refuse to pay because it is not licensed for cancer. A standing promise to pay would remove that fear.

Surgery stress may help hidden cancer cells spread. A five-day course of two cheap old drugs around the operation might block that, and small trials look promising.

AI systems claim to find new uses for old drugs, but their predictions are rarely tested fairly. Publish their cancer predictions in advance and score them against trial results.

Antibiotics given in the weeks before immunotherapy are linked to much worse results. A simple stewardship rule could preserve benefit at no cost.

Patients who happened to take common allergy pills during immunotherapy seemed to live longer in a large records study. A simple randomised trial would show whether the pills really help.

The big metformin cancer trial failed after years and millions, despite strong observational hints. Cheaper checks on causality should be passed before funding the next one.

Cancer cells in the blood wrap themselves in platelets as camouflage. Aspirin may remove that cloak, and it is cheapest to test in the patients at highest risk of relapse.

People who eat more fibre appear to respond better to immunotherapy, while some probiotic supplements may do the opposite. A proper trial would settle it.

Nobody funds trials of old drugs because competitors can sell the result for free. A short exclusive period for the new use, like the one given for children's studies, would change that.

Certain vaccines and fungal sugars reprogramme the bone marrow so it produces more aggressive immune cells for months. That could be used before immunotherapy.

Indian trials have shown that tiny daily doses of old oral chemotherapy drugs can help patients with head and neck cancer at a cost of a few dollars a month. These regimens should be proven and adopted worldwide.