An automated pipeline emulating trials of every common drug against every cancer
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.
Nordic registries, UK CPRD and OpenSAFELY, US VA and Medicare, and Korean and Taiwanese national databases together cover hundreds of millions of people. Target trial emulation with active-comparator new-user designs, pre-registered protocols and negative-control outcomes can screen drug-cancer pairs systematically rather than one paper at a time. The proposal is an open, federated pipeline that runs a common protocol across databases for a defined library of drugs and cancer outcomes, publishes all results (including nulls) with bias diagnostics, and feeds a public prioritisation list for the repurposing fund.
- 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.
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.