# An automated pipeline emulating trials of every common drug against every cancer

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

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: The pipeline identifies at least five drug-cancer pairs with concordant protective associations across three or more independent databases and negative-control checks within two years, and at least one enters a randomised trial.
- Rationale: Single-database observational studies have produced many false leads; federated, pre-registered, multi-database analysis with shared code is the only way to separate robust signals from artefacts at scale.
- Proposed test: Build the pipeline for 50 drugs and 10 cancers across four databases, publish concordance results, and compare with known positives (aspirin-colorectal) and known negatives (metformin-breast).
- Maturity: preclinical-evidence
- Actor: data

## Sources

- Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014): https://doi.org/10.3332/ecancer.2014.442

## Connected records

- terms: [Real-world evidence](https://onco.cc/terms/real-world-evidence/)
- bottlenecks: [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/), [Weak real-world evidence and registries](https://onco.cc/bottlenecks/b-real-world-evidence/)
- key papers: [The Repurposing Drugs in Oncology (ReDO) Project](https://onco.cc/key-papers/paper-pantziarka-ecancermedicalscience/)

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