SMART designs to test treatment strategies, not just single drugs
Real treatment is a series of decisions: start with this, switch to that if it fails. Sequential multiple-assignment randomised trials test whole strategies by randomising patients again at each decision point.
SMART designs re-randomise participants at pre-specified decision points (e.g., at first progression or at ctDNA rise) to compare adaptive treatment strategies, estimating the best dynamic regime rather than the best single drug. Used in behavioural science and some leukaemia trials, rarely in solid tumours. Combined with a platform structure, this can address resistance-driven sequencing.
- 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.
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
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not linked directly; found by shared links- IdeaFund a biopsy at progression, every time, as standard care
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- IdeaCut off the emergency programme cancer cells use to survive treatment
Shares Drug resistance (primary and acquired), Acquired resistance to every therapy.
- IdeaAutonomous closed-loop adaptive therapy driven by blood tests and evolutionary models
Shares Drug resistance (primary and acquired), Circulating tumour DNA (ctDNA), Acquired resistance to every therapy, Prostate cancer.
- IdeaEvolution-guided 'adaptive therapy' dosing tested in randomised phase 2 trials
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- IdeaPre-consented cohorts that can be randomised to future trials (TwiCs)
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- IdeaTest intermittent dosing of targeted drugs to delay resistance, with honest priors
Shares Drug resistance (primary and acquired), Circulating tumour DNA (ctDNA), Acquired resistance to every therapy.
- IdeaBlock the chemical switch that lets cells hide from treatment
Shares Drug resistance (primary and acquired), Acquired resistance to every therapy.
- IdeaTurn off the error-prone repair that manufactures resistance mutations
Shares Drug resistance (primary and acquired), Acquired resistance to every therapy.