OnCo
ideasIdea

A billion-dollar prize for the first durable cure of a lethal metastatic cancer

Governments and foundations would pledge a very large prize, paid only when a treatment is shown to keep most patients with a currently incurable metastatic cancer alive and disease-free for five years.

A pull incentive that pays for the outcome the system currently under-rewards. The prize is defined in advance per disease (for example metastatic pancreatic adenocarcinoma, glioblastoma, metastatic TNBC) with an objective bar such as at least 50% five-year disease-free survival in a randomised or well-controlled registration cohort where the historical figure is under 5%. The winner keeps its patent but accepts a price ceiling and global access licensing as a condition. Multiple sponsors could pool into a single escrowed fund; a partial prize could be paid for intermediate milestones (for example 25% durable remission).

Hypothesis
A credible, escrowed cure prize of one billion dollars or more per disease increases the number of registered first-in-class programmes in the named diseases by at least half within five years and attracts new entrants (academic spin-outs, non-oncology companies) that the current market does not.
Rationale
Pull mechanisms have worked where the goal is well-specified and the market signal weak: the Ansari X Prize, the Longitude Prize, Gavi's advance market commitment and DARPA challenges. Current oncology rewards are indifferent to magnitude of benefit, so capital flows to predictable incremental gains; a prize inverts the payoff curve for the hardest problems.
What would test it
Announce a single-disease prize with a fully escrowed fund and pre-registered success criteria, then track new programme registrations, venture funding and phase 1 starts in that disease against matched diseases without a prize over five years.
Maturity
speculative
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
10
Bottlenecks it attacks

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