# Just-in-time site activation: open a site in two weeks when a patient appears

Source: https://onco.cc/ideas/idea-tr1-just-in-time-site-network/  
OnCo record `idea-tr1-just-in-time-site-network` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Instead of opening a trial at fifty hospitals and waiting for patients, keep a network of pre-vetted clinics ready and switch a trial on where a matching patient is found.

## Summary

A network of community and academic sites holds master agreements, a central IRB, standing budgets and trained staff; when a matched patient is identified (via matching tools or referral), the site is activated for that protocol within 10-14 days. TAPUR and some rare-tumour and biomarker-defined trials have used this model; the idea is to make it the default for biomarker-selected phase 2 and rare-cancer trials and to fund the network as infrastructure.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Biomarker-selected trials run through a just-in-time network will reach target accrual in less than half the calendar time of conventional site selection and at lower cost per enrolled patient, because idle-site costs are removed.
- Rationale: In conventional trials a large share of opened sites enrol zero or one patient, while eligible patients at non-participating sites are never enrolled. JIT inverts the logic: capacity follows the patient.
- Proposed test: Run two similar biomarker-selected phase 2 studies from one sponsor, one via JIT network and one via conventional site selection, and compare time to accrual, cost per patient and geographic spread of enrolled patients.
- Maturity: early-clinical
- Actor: industry

## Sources

- ASCO TAPUR Study: https://www.tapur.org/

## Connected records

- technologies: [AI trial matching & clinical decision support](https://onco.cc/technologies/ai-trial-matching/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Basket, umbrella, and platform trials](https://onco.cc/terms/basket-umbrella-platform/)
- bottlenecks: [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)

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