Add a cheap-drug factorial arm to every cooperative-group adjuvant cancer trial
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.
Factorial designs randomise the same patients to two independent questions, sharing recruitment, follow-up and infrastructure. Add-Aspirin ran as a standalone trial; embedding similar questions as second factors in cooperative-group adjuvant trials (breast, colorectal, lung, prostate) would multiply the number of repurposing questions answered at a small marginal cost. The proposal is a policy by public trial funders (NCI cooperative groups, CRUK, EORTC) that every new large adjuvant trial include, where feasible, a factorial randomisation to a prioritised off-patent candidate, with a central committee selecting candidates and monitoring interactions.
- No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.
- Trial design, endpoints and cost · A phase 3 trial takes years and hundreds of millions of dollars, and often answers a question that has already moved on.
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