ideasIdea
A trials fund reserved for older and multimorbid patients
Most people with cancer are over 65, but most trial patients are younger and fitter. A dedicated fund would pay for trials designed for the patients we actually treat.
Public and charitable funders create a standing fund for trials with inclusive eligibility (age, kidney function, performance status, comorbidity), geriatric assessment-guided dosing, and endpoints that matter to older adults (function, independence, time at home). Trials would test dose reductions, shorter courses and de-escalation of standard regimens in patients over 70, where retrospective data suggest toxicity and discontinuation are far higher than in trials. Industry has little incentive to run these because they mostly test less drug.
Hypothesis
A dedicated fund produces at least five phase 3 results in older adults within eight years that change guideline dosing or regimen choice, and increases the median trial age in the funder's portfolio by at least five years.
Rationale
The GAP70+ and GAIN trials showed geriatric assessment reduces toxicity; French GERICO and UK trials demonstrated feasibility of elderly-specific phase 3s. The gap is sustained funding, not method.
What would test it
Launch the fund for one cycle and compare median participant age, toxicity-driven discontinuation and guideline impact with the funder's general trials portfolio.
Maturity
speculative
Who has to act
policy
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.