Pre-consented cohorts that can be randomised to future trials (TwiCs)
Patients join a long-term cohort once and agree in advance that they may be offered new treatments as they appear, while others in the cohort serve as the comparison group. No new trial has to start from zero.
The 'trials within cohorts' (TwiCs, or cohort multiple randomised controlled trial) design enrols a disease cohort with staged consent: patients agree to data collection and to being randomly selected for future interventions; those selected are offered the intervention, the rest continue standard care as controls. Utrecht's UMBRELLA breast cancer cohort has run several such trials. The idea is a cohort per major cancer in each large network.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
- 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.
Pages like this
not linked directly; found by shared links- IdeaBorrow from past control arms to shrink the control group in phase 3
Shares Trials enrol too few, too slowly, Trial design, endpoints and cost, Colorectal cancer.
- IdeaA standing platform trial for every major cancer, funded as infrastructure
Shares Trials enrol too few, too slowly, Trial design, endpoints and cost, Prostate cancer.
- InstitutionThe Ottawa Hospital Cancer Centre / Ottawa Hospital Research Institute
Shares Trials enrol too few, too slowly, Trial design, endpoints and cost, HR-positive / HER2-negative breast cancer, Colorectal cancer.
- IdeaSMART designs to test treatment strategies, not just single drugs
Shares Trial design, endpoints and cost, Prostate cancer, Colorectal cancer.
- IdeaRandomise inside the cancer registry: registry-based trials for everyday questions
Shares Netherlands Cancer Institute (NKI-AvL), Trials enrol too few, too slowly, Trial design, endpoints and cost.
- IdeaPoint-of-care randomisation built into the oncology record
Shares Trials enrol too few, too slowly, Trial design, endpoints and cost.
- IdeaPragmatic trials in patients over 75 with function, not just survival, as the primary endpoint
Shares Trials enrol too few, too slowly, Trial design, endpoints and cost.
- PersonRené Bernards
Shares Netherlands Cancer Institute (NKI-AvL), HR-positive / HER2-negative breast cancer, Colorectal cancer.