# A non-profit phase 1b combination unit that any drug owner can use

Source: https://onco.cc/ideas/idea-tr2-combination-utility/  
OnCo record `idea-tr2-combination-utility` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Build a shared, not-for-profit clinical unit that runs early combination trials to a standard recipe, so that small companies and academics can test pairs without building their own trial machinery.

## Summary

Early combination trials repeat the same work: pharmacokinetic interaction, overlapping toxicity, dose finding. A utility unit with standard protocols, pre-negotiated site contracts and a fixed price per arm (analogous to a contract research organisation but mission-driven and data-open) would lower the barrier for combinations that no single company will sponsor, especially those pairing drugs from different owners.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: The unit will run combination phase 1b arms at less than half the cost and time of industry-sponsored equivalents and will publish every result, positive or negative, within a year of completion.
- Rationale: Shared infrastructure works elsewhere in science (synchrotrons, sequencing centres). The UK Experimental Cancer Medicine Centres show the model at national scale.
- Proposed test: Fund a unit for five years with a mandate of twenty combination arms; audit cost, time and publication rate against matched industry trials.
- Maturity: speculative
- Actor: philanthropy

## Sources

- Bottleneck evidence (Too many combinations to test): Palmer & Sorger, Combination cancer therapy can confer benefit via patient-to-patient variability without drug additivity or synergy (Cell 2017): https://doi.org/10.1016/j.cell.2017.11.009

## Connected records

- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/), [The Institute of Cancer Research](https://onco.cc/institutions/icr-london/), [The Royal Marsden](https://onco.cc/institutions/royal-marsden/)
- ideas: [A publicly held library of investigational drugs available for academic combination trials](https://onco.cc/ideas/idea-tr2-public-combination-formulary/)
- bottlenecks: [The valley of death between lab and product](https://onco.cc/bottlenecks/b-translational-valley/), [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/)
- key papers: [Combination Cancer Therapy Can Confer Benefit via Patient-to-Patient Variability without Drug Additivity or Synergy](https://onco.cc/key-papers/paper-palmer-cell/)

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