# Factorial trials that test several cheap generics at once in the adjuvant setting

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

## TL;DR

One large trial can test aspirin, a statin, metformin and exercise at the same time by randomising each separately, answering four questions for the price of one.

## Summary

A 2x2x2 factorial randomises each patient to each intervention independently, so main effects of several low-cost interventions are tested with the same participants. The Add-Aspirin trial and the earlier ATAC-style factorials show feasibility. Generic repurposing candidates have no sponsor, so factorial efficiency is the only way many will ever be tested.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A factorial adjuvant trial of three generics in colorectal cancer will report main effects for all three with adequate power at a per-question cost below one third of separate trials.
- Rationale: Interventions with different mechanisms rarely interact strongly; factorial designs exploit this. Cooperative groups have the infrastructure.
- Proposed test: Design and fund a 2x2x2 factorial in stage III colon cancer (for example aspirin, a statin and vitamin D) with disease-free survival as the primary endpoint.
- Maturity: early-clinical
- Actor: research

## Sources

- Add-Aspirin trial: https://www.addaspirintrial.org/

## Connected records

- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/)
- ideas: [A perpetual platform trial in every major cancer, funded as infrastructure](https://onco.cc/ideas/idea-tr2-perpetual-platforms/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- bottlenecks: [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/), [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/)

---
JSON: https://onco.cc/api/v1/entities/idea-tr2-factorial-adjuvant-generics.json