# A standing platform trial that assigns treatment by how the tumour escaped

Source: https://onco.cc/ideas/idea-bio1-resistance-platform-trial/  
OnCo record `idea-bio1-resistance-platform-trial` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Instead of a new trial for each resistance mechanism, one continuous trial could sort patients into arms based on the reason their last treatment failed.

## Summary

A perpetual master protocol with a common progression-biopsy and plasma workup, a shared control arm and arms opened and closed as mechanisms and matched agents emerge. This shares infrastructure across sponsors, gives patients a reason to have the biopsy, and produces mechanism-specific efficacy estimates that no single-sponsor trial can. Precedents include Lung-MAP and I-SPY in other settings.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A resistance platform enrols faster and produces mechanism-specific efficacy answers at lower cost per arm than separate single-mechanism trials, with a majority of enrolled patients receiving a matched agent.
- Rationale: Resistance mechanisms are individually rare but collectively common, which is exactly the situation platform designs handle best; the workup requirement is the same for all arms.
- Proposed test: Launch with three arms in one disease area, and compare cost per randomised patient, time to first readout and screen-failure rate with matched standalone trials.
- Maturity: speculative
- Actor: research

## Sources

- Bottleneck evidence (Acquired resistance to every therapy): Soria et al., Osimertinib in untreated EGFR-mutated NSCLC (FLAURA, NEJM 2018): https://doi.org/10.1056/NEJMoa1713137

## Connected records

- technologies: [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/)
- terms: [Basket, umbrella, and platform trials](https://onco.cc/terms/basket-umbrella-platform/)
- bottlenecks: [Acquired resistance to every therapy](https://onco.cc/bottlenecks/b-resistance/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)
- roadmaps: [Targeted therapy roadmap: imatinib → designed for resistance → the undruggable drivers fall](https://onco.cc/roadmaps/targeted-therapy-roadmap/), [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)

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