# A perpetual platform trial in every major cancer, funded as infrastructure

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

## TL;DR

Instead of starting a new trial for every drug pair, keep one always-open trial per cancer that new arms can join and leave, sharing the same control group.

## Summary

STAMPEDE (prostate) and I-SPY 2 (breast) showed that a standing master protocol with a shared control arm can test a succession of treatments for a fraction of the cost and time of separate trials. Yet most common cancers still have no perpetual platform. The proposal is a ten-year, ring-fenced infrastructure grant per tumour type (lung, colorectal, pancreas, ovary, bladder, glioma, myeloma and others) so that the platform outlives any single sponsor or investigator.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Cancers with a funded perpetual platform will evaluate at least three times as many combination arms per year, at less than half the per-arm cost, compared with matched cancers relying on stand-alone trials, within five years of funding.
- Rationale: STAMPEDE randomised over 10,000 men across ten arms with a single control population and changed standard of care three times. Shared controls, standing ethics approval and pre-built data pipelines remove the fixed costs that make combination trials slow.
- Proposed test: Fund platforms in two cancers without one (for example pancreas and glioma) and compare arms opened, accrual rate and cost per randomised patient against the two prior years of conventional trials in the same disease.
- Maturity: being-tested-at-scale
- Actor: philanthropy

## Sources

- STAMPEDE trial: http://www.stampedetrial.org/
- I-SPY trials: https://www.ispytrials.org/

## Connected records

- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- terms: [Basket, umbrella, and platform trials](https://onco.cc/terms/basket-umbrella-platform/)
- trials: [STAMPEDE](https://onco.cc/trials/stampede/)
- bottlenecks: [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- ideas: [Factorial trials that test several cheap generics at once in the adjuvant setting](https://onco.cc/ideas/idea-tr2-factorial-adjuvant-generics/)
- roadmaps: [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)

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