# One master trial for cancer prevention drugs across many precancers

Source: https://onco.cc/ideas/idea-prev-chemoprevention-master-protocol/  
OnCo record `idea-prev-chemoprevention-master-protocol` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Prevention drug trials run separately in each precancer and are slow. One master protocol with shared infrastructure across Barrett's oesophagus, oral leukoplakia, lung nodules and pancreatic cysts, using regression as an intermediate endpoint and adding or dropping arms adaptively, would test several drugs at once.

## Summary

Each precursor cohort has small stand-alone chemoprevention trials. Propose a master protocol with shared infrastructure, biomarker-defined precursor cohorts, intermediate endpoints (regression, progression-free interval), and adaptive arm addition and dropping, funded jointly by NCI's prevention network and philanthropy.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A platform cuts time from candidate agent to phase 2 readout from about eight years to about three and tests at least three times more agents per dollar than stand-alone trials.
- Rationale: Platform trials (I-SPY, STAMPEDE) achieved this in treatment; precancers share biology such as chronic inflammation and immune escape.
- Proposed test: Launch with three precursor cohorts and four agents; evaluate throughput at four years.
- Maturity: speculative
- Actor: research

## Sources

- Bottleneck evidence (Prevention we already have is not deployed): Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018): https://doi.org/10.3322/caac.21440

## Connected records

- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/)
- institutions: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [Basket, umbrella, and platform trials](https://onco.cc/terms/basket-umbrella-platform/)
- bottlenecks: [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- key papers: [IBIS-I: five years of tamoxifen keeps preventing breast cancer for at least 20 years](https://onco.cc/key-papers/paper-ibis-i-tamoxifen-lancet-oncol-2015/), [PREDIMED: a Mediterranean diet with extra-virgin olive oil and fewer breast cancers](https://onco.cc/key-papers/paper-predimed-breast-jama-im-2015/), [Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States](https://onco.cc/key-papers/paper-islami-ca-cancer-j-clin/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)

---
JSON: https://onco.cc/api/v1/entities/idea-prev-chemoprevention-master-protocol.json