BRCA1 breast cancers seem to grow from cells driven by the RANK signal. Denosumab blocks it and is already used for bone. A trial is testing whether it prevents these cancers.
For some cancers, drugs and radiotherapy can now cure without removing the organ, sparing patients a stoma, a lost voice or a removed bladder. A dedicated programme would run the trials to prove where this is safe.
Set a legal limit: anyone referred with suspected cancer should be told within 28 days whether they have it. Publish how every hospital performs each month.
Blood tests can now find leftover cancer months before scans, but most patients who test positive have nothing to enrol in. One standing trial per country would fix that.
Every newly diagnosed patient gets a named person whose job is to get them through appointments, tests, paperwork and money problems. Insurers should pay for it because it prevents delays and dropouts.
Trials that test many companies' drugs side by side against one shared control work best when nobody's company runs them. A standing non-profit sponsor would make this the norm rather than a rare exception.
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.
No company will pay to find out whether six months of its drug works as well as twelve. A dedicated public fund would pay for those trials, which save patients side effects and health systems money.
Some chemotherapy and antibody drugs damage the heart. Checking heart function before and during treatment and starting protective drugs early for those at risk could prevent much of that damage.
Rare cancers are often misdiagnosed, which sends patients down the wrong treatment path. Digital slide sharing could get every case to an expert within days.
Rather than building a new trial from scratch for every drug, keep one permanent trial open per cancer where new treatments can be slotted in and dropped out, sharing the same patients, control group and infrastructure.
A pill on a string collects cells from the food pipe and finds Barrett's oesophagus, a precursor of cancer. Offering it in pharmacies to people on long-term heartburn drugs would find it early.
Secure online workrooms where approved researchers can analyse cancer records without downloading them, with the data already cleaned and organised for cancer questions.
Papillary thyroid cancers under 1 cm almost never cause harm. Japanese hospitals have watched thousands safely. Make watching, not surgery, the default everywhere, with a registry.
A cancer patient with a fever or severe sickness during treatment should be seen quickly by a team that knows chemotherapy, not wait hours in a general emergency room.
Radiation therapists, the staff who deliver daily treatment, can be trained to outline normal organs on scans and to review patients during treatment, work that oncologists now do.
Low-risk DCIS is a breast change that may never become cancer. Trials now show watching it is safe in the short term. The next step is a proper pathway and a name that does not say cancer.
When a prediction model says a patient has a high chance of dying within a year, their team is prompted to have a structured conversation about what matters to them, while there is still time to act on it.
Copies of biological cancer drugs are still required to run large trials that rarely change the answer. Dropping them would cut years and tens of millions from each biosimilar.
Anyone with ovarian, pancreatic, metastatic prostate or mismatch-repair-deficient cancer should be tested for inherited mutations, but many are not. Make it an automatic, opt-out lab step.
Palliative care given from the start of treatment for advanced cancer improves quality of life and may extend it. Instead of waiting for an oncologist to remember, the system should refer automatically when the diagnosis is recorded.
When a cancer drug is approved for more uses, the company sells far more of it but the price stays the same. Japan cuts prices automatically when sales balloon; others should too.
Connect the cancer registry to death records, pharmacy records and scan reports automatically every week, so we always know what happened to every patient without anyone filling in a form.
Cheaper copies of biological cancer drugs exist but are used far less in some countries than others. Making them the default choice saves billions with no loss of benefit.
Nasopharyngeal cancer is common in southern China and is caused by a virus. A blood test for viral DNA finds it early, and a large study showed better survival. Scale it up.
Pay hospitals a single amount for a whole course of cancer treatment, with extra for following the evidence, rather than paying per visit and per drug, which rewards fragmentation.
Most people do not know alcohol causes seven cancers. Ireland is putting cancer warnings on bottles; other countries should follow and measure the effect on drinking.
Many children and adults in poorer countries stop curable cancer treatment because families cannot afford the bus fare or food while in hospital. Small, reliable payments during treatment prevent this.
The HPV vaccine prevents most cervical cancer, but false safety claims have cut uptake in several countries. Rebuild confidence locally and deliver the vaccine in schools.
Radiotherapy trials need physicists to check every plan and central review of every target drawn, which nobody pays for. Fund that infrastructure permanently so trials are faster and results are trustworthy.
Radiotherapy machines that adapt to the tumour each day cost far more than standard ones and their benefit is unproven. Payers would fund them only within registries and trials that measure whether they help.
Hepatitis C is now curable in weeks. Testing and treating where it is concentrated, and keeping those with scarring in surveillance afterwards, would cut liver cancer.
Many young patients are never told that chemotherapy may end their fertility, or are told too late to do anything. An automatic referral, triggered when treatment is ordered, would make the conversation routine.
Companies now have to file a plan for enrolling a representative mix of patients. If the trial misses the plan, the label should say so and the company should be required to fill the gap after approval.
About one in eight cancers is caused by an infection we can vaccinate against, cure or eradicate. A concerted global programme could make those cancers rare within a generation.
Scotland and Wales put a floor under the price of alcohol. Deaths from liver disease have already fallen. Cancer takes longer to show, so someone has to keep measuring for a decade.
Lung screening is a teachable moment. Giving cessation medicine and support by default at every scan, unless the person opts out, roughly doubles quit rates.
At diagnosis, people would be asked a single question: may we contact you about research that fits your cancer? Those who say yes would be findable by trial teams without repeated cold approaches.
In many places, joining a trial can leave the patient or hospital paying for the ordinary care that goes with it. Making all insurers and public systems cover those costs removes a hidden barrier.
Offer the complementary approaches that have evidence (acupuncture for nausea and pain, exercise, mindfulness, yoga) inside the cancer centre, so patients do not seek them, and worse, elsewhere.
Instead of picking the dose by how much patients can tolerate, measure drug levels in blood and relate them to both benefit and harm across patients, then choose the dose that hits the sweet spot.
Stomach cancer is largely caused by a bacterium that spreads in households. Testing and treating whole families, not individuals, would stop reinfection and prevent cancer.
Everyone of reproductive age about to have treatment that can cause infertility is offered egg, sperm or tissue freezing, paid for, before treatment starts.
Losing hair is one of the most distressing side-effects of chemotherapy and can often be prevented with a cooling cap. Make it routinely available and paid for.
Most cancer patients are over 65, yet treatment is chosen by age and guesswork and trials exclude them. Assess fitness properly and design trials that include real older patients.
A short structured check of memory, mobility, nutrition and medicines before treatment cuts serious side effects in older patients without reducing benefit. It should be automatic, not optional.
When a geriatrician helps manage older patients around the time of a cancer operation, complications, delirium and hospital stays fall. This should be standard for anyone over 75 having major cancer surgery.
A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately.
Aspirin roughly halves bowel cancer in Lynch syndrome, and a dose trial is defining how little is needed. Most carriers are still not prescribed it; the task is to fix prescribing.
Most children with cancer in rich countries are cured; most in poor countries are not, often because cheap drugs are missing. A global platform now ships quality drugs free; scaling it to 50 countries would be one of the highest-value cancer interventions available.
For frail older patients, the journey to hospital can be the hardest part of treatment. Nurses can safely give some cancer treatments at home, which may help more people complete their course.
Many hospital stays for cancer patients, such as for fever after chemotherapy in low-risk cases, could be delivered at home with daily nurse visits and remote monitoring, which patients prefer and which is cheaper.
Women can collect their own sample for the virus that causes cervical cancer; those who test positive can be treated the same day with a simple heat device. Done nationally, this could eliminate a disease that still kills hundreds of thousands of women a year.
For very rare cancers, patients are scattered across countries. Patient-driven projects can gather records, saliva and tumour samples by post and share the data openly.
Join the national list of who got cancer to the genetic profile of each tumour, so we can see for the whole population which mutations matter and which drugs work for them.
Uganda makes liquid morphine from powder in a simple facility and lets trained nurses prescribe it, giving pain relief to patients that no doctor will ever reach. Other countries could copy this within a year.
Pack-year rules miss many people who get lung cancer, including East Asian women who never smoked. A risk score with family history and ancestry would find more cancers per scan.
Giving radiotherapy in five larger doses over one week instead of 15-25 smaller doses is proven safe for breast and prostate cancer and could treat three times as many patients on the same machines.
Trials show older women with the lowest-risk breast cancers gain almost nothing from radiotherapy after lumpectomy. Yet most still get it. Track and reward omission.
A patient with a rare cancer treated at a small hospital should have their case reviewed by the national experts by video before treatment starts. Make that referral automatic.
Scotland's minimum price per unit cut alcohol deaths. Tracking alcohol-related cancer incidence over the next decade would show whether it also prevents cancer.
Give adjuvant treatment by the tumour's molecular class rather than by stage and grade: nothing for POLE-mutated, immunotherapy for MMRd, chemotherapy plus targeted agents for p53-abnormal, hormones for NSMP.
PSA screening finds too many harmless cancers. Using PSA plus a genetic risk score to select men, and MRI before any biopsy, finds the dangerous ones and skips the rest.
A few weeks of exercise, nutrition and mental preparation before a big operation helps older patients recover faster and with fewer complications. It costs little and should be routine.
Instead of one overwhelmed national cancer hospital, organise care in tiers: district hospitals diagnose and give simple treatment, regional centres give chemotherapy and surgery, and the hub handles radiotherapy and complex cases.
Most of the world's people who die in cancer pain have no access to morphine, a drug that costs pennies, because of restrictive national rules. Fixing the rules, not inventing new drugs, is the answer.
A swallowed sponge on a string can sample the oesophagus in a GP's office. Screen people with chronic reflux to catch adenocarcinoma at a curable stage.
Trained nurses following strict written protocols can safely run chemotherapy clinics for common cancers, with an oncologist available by video for decisions and problems.
Most follow-up visits after successful treatment are routine. Nurse practitioners can run them well, giving survivors more time and oncologists more capacity for new patients.
Most people with BRCA or Lynch mutations do not know until they get cancer. Testing everyone once for a short list of high-impact genes would find them in time to prevent it.
There are too few genetic counsellors to see every patient who should have an inherited-risk test. Let the cancer team order the test with a short consent script, and use video counsellors for those with results that matter.
Rare cancers together are a fifth of all cancers, but each is too small for its own trial. One permanent trial with many arms would give all of them a route.
A woman with a breast lump should be examined, scanned and biopsied on the same day, and hear the result within a few days, rather than visiting four times over two months.
Oesophagectomy is one of the hardest operations in surgery. If chemoradiation (with or without immunotherapy) has made the tumour disappear, skip it and watch.
Palliative care given early alongside cancer treatment improves quality of life and sometimes survival, and most of the world has no access to it or to morphine. Make both universal.
Many patients with advanced lung or bowel cancer start treatment without the gene tests that would show whether a targeted drug would work. Let the pathologist order the full test the moment cancer is confirmed, without waiting for an oncologist.
Every person told they have cancer gets a named navigator, by law, who helps them understand options, book appointments, find trials and deal with money and work.
Doctors record only part of what patients suffer. Make it compulsory that patients report their own side-effects in every trial used to approve a drug, and that those data are published next to the doctor-graded ones.
Every cancer clinic would collect patients' own reports of symptoms and quality of life through a standard questionnaire that feeds straight into the record and into research datasets.
Hospitals are paid for each radiotherapy session, so a proven five-session course earns less than an unproven twenty-five-session one. Paying per course removes the reason to give more treatment than needed.
Many low-risk patients get operations and radiotherapy they may not need. Health systems would fund the trials that find out who can safely skip them, and keep the savings.
When a health system pays for a new, uncertain cancer drug, it would require that every patient's outcome is recorded and that a pre-agreed analysis decides whether payment continues.
If you join a cancer trial you should be told what it found, in plain words, within twelve months of the results, including if the treatment did not work.
Proton therapy costs far more than standard radiotherapy and, for most adult cancers, nobody knows whether it is better. Payers would cover it only inside trials or registries that answer that question, across every centre at once.
Countries buying cancer drugs alone pay more and face shortages. Buying together, as they already do for childhood cancer drugs and vaccines, cuts prices and secures supply.
Most people carrying a high-risk cancer gene do not know it until someone in the family gets cancer. Offer testing to all adults so carriers can be protected before that happens.
Give combinations before surgery and look at how much tumour is left when it is removed. That answer comes in months, so many pairs can be tested quickly.
Project ECHO is a weekly video class where district doctors and nurses present real cases to a specialist team, learn by doing, and build a network. It worked for hepatitis C and could work for cancer.
Arm swelling after breast cancer surgery is common and lifelong once established, but if caught early with simple measurements and treated with a sleeve, most cases can be prevented from becoming permanent.
The WHO set three simple goals for breast cancer: most cancers found early, diagnosis within 60 days, and most patients finishing treatment. Every country should publish how it is doing on each, every year.
Where you have your cancer operation strongly affects whether you survive it. Publishing each hospital's adjusted results would push complex surgery towards the centres that do it well.
Many approved cancer drugs probably work just as well at half the dose, which would halve their side effects and cost. Companies will not test this, so payers and public funders should.
Cytisine costs a few dollars per course and works about as well as varenicline, but is unavailable in most countries. Global approval and procurement would make quitting affordable.
Before a results or treatment-planning appointment, patients receive a list of good questions to ask, tailored to their situation, and can tick the ones they want covered.
Cancer drugs are usually tested at the highest dose patients can stand, and that dose sticks for life. Comparing two or more doses head-to-head before the big trial would find doses that work as well with fewer side effects.
Immunotherapy is often given for two years or until it stops working, but responses can last long after stopping. Trials that randomly assign responders to stop or continue would show whether the extra year is needed.
Weight loss, fatigue and unexplained pain do not point to one organ, so patients bounce between specialists. A single clinic that investigates such symptoms quickly finds cancers that would otherwise be found late.
Rather than sending a handful of trainees to Europe or America, build a few large training centres in Africa and South Asia that train the whole team together, with local case mix and local costs.
Most ovarian cancers start in the fallopian tubes. Removing the tubes at hysterectomy, or instead of tying them, as British Columbia has done, appears to prevent ovarian cancer.
Not every survivor needs to see an oncologist every six months for years. Sort people by recurrence risk, send low-risk survivors back to their family doctor with a clear plan, and guarantee rapid return if something changes.
Sweden's MASAI trial showed AI can safely replace one of two radiologists. Rolling it out region by region in a randomised order would prove it works at national scale and that interval cancers do not rise.
Where women cannot return for results, test for HPV and treat any precancer the same day with a battery-powered heat probe. This is the fastest route to WHO's cervical elimination target.
Instead of stopping after the mid-sized trial, waiting a year, then starting the big one, run them as one study with a clear pre-agreed rule for continuing. This saves a year or more per drug.
One shot for girls and a mail-in swab for women could hit the WHO 90-70-90 targets at a fraction of the cost of the traditional three-dose, clinic-based model.
One radiotherapy session relieves bone pain as well as ten, according to many trials, yet most patients still get the longer course. Making one session the default would spare patients trips and free machines.
Many countries have one pathologist per million people. Putting a slide scanner in each district lab and sending images to a pooled group of pathologists could give a cancer diagnosis in days instead of months.
Banning tobacco sales to anyone born after a set year, as the UK is doing, could end smoking within a generation. Adopting countries should coordinate evaluation so the evidence is undeniable.
For each cancer type, agree the set of stains and tests that are always needed, and have the lab run them automatically on diagnosis rather than waiting for someone to ask.
South Korea's thyroid cancer rate rose 15-fold after ultrasound screening, with no fall in deaths. A firm rule not to biopsy nodules under 1 cm, and not to screen, would prevent this harm elsewhere.
The CHALLENGE trial showed a supervised exercise programme improves survival in colon cancer. Extend it to breast, prostate, and lung cancer with the same rigour.
People most at risk of lung cancer are least likely to attend hospital screening. Manchester showed mobile scanners in car parks reach them. Make this the default model.
A cheap gene test before starting common chemotherapy identifies people at high risk of severe or fatal side effects so their dose can be lowered. Europe recommends it; many places still do not do it.
Patients with advanced cancer often never have a clear conversation about what to expect and what matters to them. A structured conversation guide, taught to clinicians and prompted by the record, makes these talks happen earlier.
People should not have to pay to be in a trial. Sponsors would routinely cover travel, hotel and food costs, paid up front rather than claimed back, which is already accepted by regulators as fair rather than coercive.
Hepatitis B causes most liver cancer worldwide, and cheap tablets suppress it. Treating everyone infected, not just those with liver damage, would prevent many cancers.
Regulators in several countries already look at the same cancer drug dossier at the same time. Let them split the work and write one report instead of six.
Sequence every cancer at diagnosis, along with the patient's inherited genes, and pool the results with treatments and outcomes so every patient teaches the system how to treat the next.
Giving immunotherapy for a few weeks before surgery produces a tumour sample that shows exactly what the drug did. That is the fastest way to learn who responds.
Drawing targets and planning radiotherapy takes hours of scarce expert time. Properly tested AI could do much of it, letting the same staff treat far more patients, if regulators and payers set clear rules for proving and paying for it.
A large trial showed that palliative care delivered by video works as well as in person for people with advanced lung cancer. Payers should cover it so that distance from a hospital no longer decides who gets it.
In Kerala, trained community volunteers, backed by nurses and doctors, provide most home palliative care to the dying. The model reaches more people at lower cost than any clinic-based service and could be copied.
Patients on chemotherapy who report their symptoms weekly through an app, with nurses acting on alerts, live longer and visit emergency rooms less. This should be routine and paid for.
Patients on chemotherapy or immunotherapy answer a short weekly symptom questionnaire on their phone; severe answers alert the nurse the same day. Trials show this prolongs life.
If the FDA and EMA have both approved a cancer drug, a smaller country should be able to approve it in three months using their reports rather than starting over.
A positive blood test with no known tumour is frightening and hard to manage. A standard imaging cascade with a time limit, and a registry of what was found, would make these tests usable.
A Japanese trial found vitamin D supplements did not help everyone after digestive cancer surgery, but appeared to help a subgroup identified by a tumour marker. That subgroup deserves its own trial.
A small team monitors social media and news for spreading cancer falsehoods and publishes clear, sourced rebuttals within two days, before the claim becomes established.
A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.
Blood tests can already detect tumour DNA. Reporting which sub-populations of the tumour are growing or shrinking, cycle by cycle, would turn the test into an evolution monitor.
When two expensive cancer drugs are combined, the price is often the sum of both even though the extra benefit is smaller. A rule for splitting the total value between them is needed.
Blood and tissue samples collected in cancer trials are the best material for validating new tests, but most sit unused under contracts that make access impossible. A commons would make them available for approved research.
Companies stop developing many drugs that were safe but did not work in the disease they tried. Sharing those drugs and their data lets others test them where they might work.
Ultra-fast radiotherapy may spare healthy tissue while still killing tumours, but every centre is testing it differently. A coordinated programme would agree the measurements and run the trials that settle whether it works.
A handful of ageing research reactors make most cancer isotopes. Coordinating their maintenance and funding reserve capacity would prevent the shortages that stop treatments.
Malnutrition is the commonest untreated complication in cancers of the gut, throat and pancreas. Putting a dietitian in the meeting where treatment is decided means it is seen and treated before chemotherapy starts, not after weight has been lost.
Any oncologist could send a difficult case, with the records, to a specialist centre and get a written expert opinion back within three days, free to the patient.
CHALLENGE proved exercise works in colon cancer but not how much is needed. A trial comparing doses, as we would for a drug, would tell health systems what to fund.
Cheap generic versions of targeted cancer drugs like imatinib exist, but patients with rare tumours carrying the matching mutation often cannot get them. A structured programme would treat them and collect the evidence.
Hospitals could train shared AI models on all their patients' scans and records without any data leaving the building, and jointly own the results, if someone built and governed the network.
Completed trials have stored samples. Testing a new biomarker on them with the plan written in advance is nearly as good as a new trial and far cheaper, but regulators have no clear route to accept it.
People with Lynch syndrome have a very high lifetime cancer risk from a predictable set of mutations. Vaccinate them against those shared mutations before cancer appears.
Anyone diagnosed with a rare or complex cancer gets an automatic remote review by a specialist centre, paid for by the health system, before treatment starts.
Connect hospital records across countries so that questions about how treatments work in real patients can be answered in weeks without moving the data, to a standard regulators accept.
Almost all cancer deaths are caused by spread, yet very little spread tissue is ever studied. A network collecting donated tissue within hours of death would change that.
You cannot manage what you do not measure quickly. Publishing stage at diagnosis by cancer and region every quarter, not years later, would show whether detection efforts are working.
Patients moving between hospitals often carry paper folders or nothing. A standard electronic summary of diagnosis, treatments, and doses that any system can read would stop repeated tests and dangerous gaps.
Most people with cancer are over 65, but trials mostly enrol younger, fitter people. Requiring a group of older patients, assessed for frailty, in every big trial would show whether the drug works and is safe for those most likely to receive it.
The official information about a new cancer drug must include what patients on the trial actually reported about side-effects and daily life, not only survival curves.
Before an AI tool is allowed to influence care at a hospital, it would run invisibly alongside clinicians for months so its real-world performance at that site is known first.
Test the large language models doctors and patients are already using against a continually refreshed set of cancer questions, scoring not just correct answers but whether the sources they cite are real and support the claim.
Instead of hitting a tumour with the maximum dose until it stops working, adjust the dose to keep the tumour small and let drug-sensitive cells suppress resistant ones. Test this properly across several cancers.
Instead of asking twenty hospitals for permission, a researcher would apply once to a single national body that can grant access to all cancer records under one set of rules.
We know surprisingly little about what happens to cancer survivors twenty years on. Linking their treatment records to later health records would show which treatments cause which problems and who needs watching.
When patients who agreed in advance die of cancer, sampling every tumour within hours reveals how the disease evolved and escaped every drug. Few hospitals can do this today.
Radiotherapy machines record exactly how much dose every organ received, but the data are thrown away. Collect them and link to toxicities and cures to learn the safest, most effective doses.
After surgery or curative treatment, everyone gets regular blood tests for leftover cancer DNA, and the pooled results power forecasts of who will relapse and trials of acting early.
Radiotherapy may make immunotherapy work better, but the trials to test this are scattered and often small. One shared platform, run by radiotherapy groups with drugs supplied by several companies, would settle it faster.
Cheap, essential chemotherapy drugs like cisplatin run out because making them is not profitable enough. A non-profit maker could guarantee supply at a fair price.
Children with cancer, and their families, need symptom relief and support from diagnosis, not only at the end. Every children's cancer unit should have a palliative team, and most in poorer countries have none.
Your entire cancer history, including scans, pathology, genomics and treatments, lives in a record you control and can share in one click with any hospital, trial or second-opinion service.
Instead of one-off small studies, run a standing trial that continuously tests new treatments for side-effects, adding and dropping arms as evidence arrives.
Surgery cures more cancer than any drug, yet most operations have never been compared in a proper trial. A standing network of hospitals, with core funding, would run those trials continuously.
Before investing in a full trial, give a few patients a tiny dose of a new compound and use scans and blood tests to see whether it reaches the tumour and hits its target. Fund these small studies as a matter of routine.
Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.
Tools that show surgeons where the tumour ends during the operation could cut the number of patients who need a second operation, but none has been properly tested at scale. A network would run those trials and pay on results.
People with cirrhosis have a high risk of liver cancer, and those who happen to take statins seem to get it less often. A proper trial would settle whether statins should be prescribed for prevention.
Companies and public funders would jointly pay for standardised experiments that confirm or refute new cancer targets, sharing all results openly, so nobody wastes years on a target that does not hold up.
When researchers use hospital records to ask 'would drug A have beaten drug B in a trial', they should follow a published recipe and register their plan first, so the answer can be trusted.
Patients now ask AI assistants about their cancer. Test those assistants regularly on real questions, publish the scores, and certify the ones that meet the bar.
Thousands of cancer biomarkers are published; almost none reach patients because nobody validates them fairly. Create a public service that tests any candidate blind against stored samples.
Cheap old drugs such as aspirin, statins, metformin and beta-blockers show hints of cancer benefit but no company will pay for the trials. Create a public fund and a way to update their labels.
Sometimes a trial cannot randomise, so the new drug is compared with past patients' records. Clear published rules on when that is allowed, and how it must be done, would replace case-by-case guesswork.
Rate sponsors on whether they publish their results, share data and register outcomes honestly. Hospitals and patients can then prefer sponsors that behave well.
Promising academic cancer discoveries stall because nobody funds the expensive step from lab to first human trial. Build a shared public facility that does exactly that step, repeatedly.
A government or charity holds stocks of experimental cancer drugs under standing agreements, so academic doctors can test combinations without negotiating with each company separately.
Lynch syndrome tumours share predictable mutations the immune system can target. A vaccine in early trials could be tested to see if it prevents polyps and cancers in carriers.
AI tools that write clinic notes are spreading fast in cancer clinics. Test them properly: do they save time, do they make mistakes about drugs and doses, and do patients notice a difference?
The UK's RECOVERY trial tested many cheap COVID drugs quickly by randomising thousands of ordinary hospital patients. Cancer needs the same machine for old drugs.
Cancer AI models are usually tested on data from the same hospital they were built on. A registry of independent test datasets, and a rule that every model reports performance on at least one, would show which models really work.
Let AI tools that improve as they learn be used under close supervision in a few hospitals, with pre-agreed rules for what changes are allowed and how they are checked.
Regulators are starting to use AI to read dossiers faster. If they shared one tool, it could show where their questions overlap and where they truly disagree.
Thousands of patients have received standard treatment in the control arms of past trials. Pooling their anonymised data would let new trials borrow from them and randomise fewer patients to old treatments.
Between diagnosis and surgery there are usually a few weeks. Giving a new drug in that window and comparing the tumour before and after surgery shows whether it hits its target in real people, quickly and cheaply.
Tumour mutational burden decides who gets immunotherapy in some settings, but every sequencing panel calculates it differently. A shared calibration would make the number mean the same thing everywhere.
Every cancer trial's anonymised patient-level data would go into one trusted repository within eighteen months of completion, with a single access committee, so researchers can re-analyse, pool and learn from trials that today stay locked up.
A small ultrasound device implanted in the skull can be switched on at each chemotherapy visit to briefly open the brain barrier, letting drugs in every cycle.
Companies with drugs that might work together rarely test them because the legal negotiation takes longer than the trial. A pre-written standard contract would fix that.
Agree one recipe for proving a pathology AI helps: first a controlled study with many pathologists and cases, then a real-world trial with turnaround, accuracy and cost measured.
Set common rules for how hospitals check that an AI tool still works as the scanners, patients and practices around it change, and when it must be switched off.
Errors happen when patients move from hospital to home, from surgery to chemotherapy, or from oncology back to their family doctor. A short standard checklist and a pharmacist medication review at each move would prevent many of them.
Most cancer drugs cannot cross into the brain. Combine ultrasound that briefly opens the barrier with drugs engineered to be carried across, and make this a standard platform for every brain tumour and brain metastasis.
Radiotherapy is given to half of all cancer patients but few new drugs are tested alongside it. A permanent trial platform would test drug-plus-radiation pairs systematically.
Cancer patients have had treatments delayed because basic chemotherapy drugs ran out. Keeping a national stockpile, like for flu antivirals, would prevent this.
When someone refuses recommended treatment, do not just record it. Offer a second conversation, address the beliefs behind it, keep the door open and track what happens.
Doctors often use cancer drugs outside their approved use based on a hunch or a small study. Record what happens every time so the hunches become evidence.
Young survivors will live sixty more years and will change doctors many times. A phone app holding their treatment history, risks and screening reminders would travel with them for life.
Publish a fake but realistic copy of each secure cancer dataset so researchers can write and test their code at home, then run the finished code on the real data.
Some people have only a few spots of spread and can be cured by treating each one. Others have many spots not yet visible. A test to tell them apart would spare futile treatment and find curable patients.
Precancer is treated by cutting away part of the cervix, which raises pregnancy risks. A vaccine that makes the immune system clear the infected cells would avoid surgery.
Obesity raises the risk of 13 cancers. Weight-loss drugs are now widely used; a large trial should test whether they actually prevent cancer, not just diabetes and heart disease.
Give every tumour board a tool that pulls up the relevant trials and guideline lines for each case with citations, records what was decided, and later shows how the patient did.
Most new cancer imaging agents and radioactive drugs start in university hospitals. A network sharing production, quality files and regulatory paperwork would get them into multi-centre trials years faster.
Most people referred for blood in the urine do not have bladder cancer, yet all get cystoscopy. A urine DNA or methylation test could safely spare most of them.
A childhood vaccine against the stomach bacterium behind most stomach cancer would prevent infection for life. One trial in China showed protection; the idea has stalled.
Surgeons' skill affects whether cancer comes back, but nobody measures it. Recording operations and rating them, increasingly with AI, then linking ratings to outcomes, would make surgical quality visible and improvable.
Blood tests increasingly find precursor conditions like MGUS and smouldering myeloma, but most never progress. A registry with clear rules would stop early treatment outside trials.
US law already requires trial results to be posted within a year and allows fines of over ten thousand dollars a day. Almost no fines have ever been issued. Start issuing them.
Large adjuvant trials already follow thousands of patients for years. Adding a second randomisation to a cheap old drug would answer repurposing questions almost for free.
Drugs are approved on trials of fit, younger patients and then given to everyone. A required follow-on trial in older, sicker and more diverse patients would show whether the benefit holds in real life.
Most screening CT scans are normal. Letting a validated AI clear them, and sending only flagged scans to a radiologist, would let screening scale without more radiologists.
Whether a lesion is called precancer or cancer varies between pathologists, and over time the bar has drifted lower. AI reference reads could hold the line.
Measuring tumours on scans for trials is slow, expensive and inconsistent between readers. Software that measures lesions and flags changes, checked by a radiologist, could make trial endpoints cheaper and more reliable.
Let validated AI make the first read on routine, high-volume samples like cervical smears and standard breast biopsy stains, so scarce pathologists spend their time on the difficult cases.
Oncologists spend hours a day typing notes. Software that listens to the consultation and drafts the note, the letter and the orders could return that time to seeing patients.
Training a specialist doctor takes ten years or more. Mid-level clinicians can be trained in eighteen months to run protocol-based cancer care under supervision, and there are far more of them.
Frailty is the strongest predictor of who will be harmed by treatment, but it is rarely measured. Software can estimate it automatically from existing records and flag patients who need a closer look.
EBV infects almost everyone and causes nasopharyngeal cancer, some lymphomas and some stomach cancers. A vaccine given before infection could remove those cancers.
Rate every cancer breakthrough story and press release for spin, using set criteria, and publish the scores so journalists, institutions and readers can see who overstates.
Trials often measure a stand-in for survival, such as time until the cancer grows on scans. An independent body would test, for each cancer and treatment type, whether the stand-in actually predicts survival, and publish the answer.
Many cancer lab results cannot be reproduced, and trials built on them fail. Fund an independent institute that re-runs important experiments before anyone spends millions on humans.
Childhood cancers are rare, so no one country sees enough cases. Pool the treatment and outcome of every child treated anywhere into one governed dataset.
Build a public, machine-readable map connecting every cancer trial to its results, the drugs and biomarkers involved, and the guideline recommendations it supports, with a source for every link.
Build a public collection where every major cancer trial has a matching analysis done on hospital data, so we learn exactly when real-world evidence can be trusted and when it cannot.
Most patients take supplements and rarely tell their oncologist. Ask routinely and check automatically for interactions with chemotherapy and targeted drugs.
Companies and public funders would pool money and scientists to crack the hardest cancer proteins, such as MYC and mutant p53, sharing everything openly until there is a real drug candidate, then competing on the final product.
Women experience more severe side effects from many chemotherapy, targeted and immune drugs than men at identical doses. Trials should analyse drug levels and side effects separately by sex and test whether women need different doses.
Drugs are processed differently by people with different genetic backgrounds, but doses are set mostly in white and East Asian populations. Every new drug should be studied for how it behaves across ancestries, with dosing advice by genotype rather than by race.
H. pylori eradication often fails because of antibiotic resistance. A stool DNA test showing which antibiotics will work would raise cure rates and protect antibiotics.
Tumours often lose one of a pair of near-identical genes. They then depend entirely on the remaining copy, which a drug can block, killing only the cancer.
Most mouse studies of cancer drugs do not randomise animals or blind the people measuring tumours, which inflates results. Checking and publishing which institutions do it properly would change behaviour.
Trials sometimes quietly swap the outcome they promised to measure for one that looks better. Software can compare the registered plan with the published paper and flag the switch.
Rather than giving the same dose until the cancer grows, measure tumour DNA in blood every few weeks and let a validated algorithm raise, lower, pause or switch drugs to keep the cancer suppressed for longer.
Anthracyclines, HER2 drugs and some newer agents can damage the heart. Monitor with blood tests and scans and start cheap heart-protective drugs early in those at risk.
When a scan shows most tumours shrinking but one growing, that odd lesion holds the escape mechanism. Sampling it, and treating it locally, should be routine.
Dozens of countries have no radiotherapy machine at all. Combine long-term finance with a machine designed to be cheap, robust and maintainable where power and engineers are scarce.
Sleeping cancer cells survive by recycling their own contents. An old malaria drug blocks that recycling and is being tested in people with no visible cancer but detectable residual cells.
When the standard treatment has been given to thousands of similar patients in earlier trials, a new trial could randomise fewer people to it and lean on that history, as long as the old data still matches.
Add immunotherapy to the two targeted pills in the most aggressive thyroid cancer, because the combination has produced multi-year survivors in early series.
Up to a fifth of people with advanced solid tumours have cancer in the brain and are usually barred from trials. Letting in those whose brain disease is treated, stable or symptom-free would widen trials and tell us whether drugs work in the brain.
Every newly diagnosed patient would be asked, as part of standard care, whether their data and leftover tissue can be used for research, so researchers never have to go back and ask.
Genetic risk scores were built mostly on Europeans and work worse in others. Funding non-European cohorts and setting a portability standard would prevent screening that widens inequality.
The lutetium used in approved prostate and neuroendocrine cancer treatments is made from an enriched metal that comes mostly from Russia. Making it elsewhere would secure supply.
Almost every clear-cell kidney cancer carries the CAIX protein. Image it with one radioactive antibody, then treat with the same antibody carrying a therapeutic isotope.
Whether a breast cancer counts as 'HER2-low', and so qualifies for a powerful drug, depends on which lab reads the slide. Standard reference slides with known HER2 levels would make the answer consistent.
MYC drives half of all cancers but has no pocket for a drug and is needed by normal cells too. The first direct MYC blockers are in trials; the question is whether there is a therapeutic window.
If Enhertu produces complete responses in two-thirds of patients before surgery, a trial should test whether some need no chemotherapy, antibodies, or even radiation afterwards.
Computers can combine minor symptoms, blood tests and age into a cancer risk score in the background. Showing that score to the GP could get more people referred earlier.
Hormone-blocking treatments for prostate and breast cancer, taken for years, raise the risk of diabetes, heart disease and bone fractures. Survivors on these drugs should get the same preventive care as diabetics.
Older cancer patients depend on family carers who receive no training or support. Paying for carer training and short breaks would keep patients at home and out of hospital.
If a CDK4-only drug matches CDK4/6 inhibitors on efficacy with less neutropenia, continuous dosing and better adherence could translate into longer control.
For choices where the right answer depends on what the patient values (watching a slow prostate cancer, adjuvant chemo at 80, breast reconstruction), a tested decision aid becomes part of the consultation.
Dozens of companies sell blood tests for tumour DNA and they report different results on the same sample. Government-issued reference samples with known amounts of tumour DNA would expose the differences.
How DNA fragments in blood are chopped up differs in cancer and can be read with cheap, shallow sequencing. Used as a first sieve, it could cut the cost of population screening.
Trials often stop following patients once the main result is in, so we never learn whether the drug extended life. Linking participants to national death and cancer registries costs almost nothing and would answer that question.
For a cancer already cured in 90% of young people, the goal is curing without the chemotherapy and radiation that cause heart disease and second cancers decades later.
Cancer cells travelling in the blood can be counted. If a drug clears them, that is an early sign it may stop spread, and it reads out in weeks rather than years.
Pancreatic tumours are packed with a type of white blood cell that shuts down the immune attack. Blocking the signal that recruits them may open the tumour to immunotherapy.
By the time patients need CAR-T their immune cells are often exhausted by earlier treatment. Storing healthy cells early would improve manufacturing success and cut the wait.
A new antibody blocks the hormone that makes people with cancer lose appetite and weight. Weight regained as muscle, not fat, needs exercise and protein alongside it.
People join trials when someone they trust explains them. Paying community health workers, churches and local groups to inform and refer people would reach communities that hospitals do not.
Millions of community health workers already visit homes for vaccines and maternal care. Training them to recognise cancer warning signs, guide patients through the system and support home pain care would reach people no hospital does.
Mouth cancer is common where tobacco is chewed and is visible to the naked eye. Health workers with a phone camera and AI could find it early in villages.
Pharmacies are everywhere and open late. They could give HPV vaccines, hand out bowel test kits, run stop-smoking clinics and offer HPV self-sampling under one roof.
Drugs approved early on promising results should lose that approval automatically if the company fails to finish the follow-up trial by the agreed date.
An Indian trial found a cheap antipsychotic pill in very low dose improved appetite and weight gain in patients with advanced stomach, lung and pancreatic cancer. It needs confirming and adopting worldwide.
Half of patients take antioxidant vitamins during chemotherapy. One good observational study suggests they raise recurrence by 40%. Patients deserve a definitive answer, and it can be obtained cheaply by adding supplement tracking to trials already running.
A trial in India found that adding a very small dose of an immunotherapy drug, about a twentieth of the usual amount, to chemotherapy improved survival in head and neck cancer. If confirmed, this could make immunotherapy affordable for millions.
Cancer AI tools are approved on old test data and then never checked again. Require every deployed tool to report its real-world performance continuously, in public.
One RAS mutation can now be drugged because it offers a reactive handle. Most RAS mutations do not, so new chemistry is needed to grab other amino acids.
Thousands of oncologists trained in poorer countries now work abroad. A structured programme could let them join weekly video case conferences for hospitals back home, improving decisions at almost no cost.
Most stage II patients never relapse, yet all are offered a year of immunotherapy. Use a blood test to treat only those with detectable residual disease.
Instead of guessing from HPV status who can get less radiation, measure the virus DNA in blood during treatment and reduce dose only when it clears fast.
Nerves feed pancreatic, prostate, and other tumours. Beta-blockers and botulinum toxin are cheap, safe, and already in trials to see if severing that link slows cancer.
Choices like mastectomy versus lumpectomy, or whether to have chemotherapy after surgery, depend on what matters to the patient. Good decision aids exist but are rarely used; building them into the clinic workflow would change that.
When a computer suggests a treatment, it should show the doctor the specific trial result and guideline sentence behind the suggestion, so it can be checked and trusted.
Trials usually take only patients who are up and about most of the day. Those who spend more time resting, a common group in real clinics, are excluded, so nobody knows how to treat them. A dedicated group in each trial would answer that.
Trials should let people in unless there is a scientific or safety reason to keep them out. Every exclusion rule would need a written reason, reviewed like the rest of the protocol.
Trials report side effects as a table of percentages that hides how long they lasted, how bad they felt and whether people stopped treatment. Tolerability should be measured with defined endpoints and a decision rule, like efficacy.
Cancer spreading along the linings of the brain is almost untreatable. Injecting engineered immune cells directly into the brain fluid, through a small reservoir, reaches it.
Published figures are cropped and processed. Requiring the original, uncropped image files to be deposited lets anyone check that the figure shows what it claims.
Trial results (hazard ratios, confidence intervals, subgroups, toxicities) would be deposited in a computer-readable form so they can be pooled, checked and used by software immediately.
Focused ultrasound, histotripsy, heat and electric-field ablation can destroy tumours without an incision, but each maker runs its own small study. Publicly-funded trials would compare them fairly against surgery.
Scan the millions of cancer slides already sitting in hospital basements and connect each to what happened to the patient, creating the world's largest training set for pathology AI.
Trial staff still retype data from the hospital record into the trial database, and monitors then check every entry by hand. Piping data directly and checking by risk would cut cost and errors.
Patients report symptoms on their phone each week; a set of rules turns severe or worsening symptoms into a dose hold or reduction before the next clinic visit. This could keep people on treatment longer and feeling better.
Antibody-drug conjugates carry potent chemotherapy into tumours but also cause lung, eye and nerve damage that depends on total exposure. Trials comparing lower doses, longer intervals and payload caps could keep the benefit while cutting these harms.
The dose for a frail 80-year-old is guessed from what fit 55-year-olds tolerated. Running dose-finding in older patients directly, using frailty assessment, would give doses they can actually take.
Measure the radiation each patient's tumour and kidneys actually absorb and adjust the number and size of doses, instead of giving everyone four identical cycles.
Many countries have one oncologist for millions of people. Train nurses and general doctors to deliver protocolised cancer care with software checks and remote specialist oversight.
Many trials require a new tumour biopsy just to enter, even when the sample is only for research. Allowing blood tests or stored tissue instead would remove a painful and risky hurdle that puts many patients off.
Many trials quietly exclude people who do not speak the local language because consent forms and questionnaires exist only in that language. Providing translations and interpreters for the commonest languages would fix this.
Many combinations are already used off-label. Careful analysis of what happened to those patients can rule out the pairs that clearly do not help before spending money on trials.
Before spending millions on a randomised trial, analyse existing patient records as if the trial had already happened. If the answer is obvious or the question is unanswerable, skip or redesign the trial.
Whenever an AI tool gives a result about a patient, the hospital system would permanently record what it saw, which version it was, what it said and what the doctor did with it.
When your biopsy or gene test comes back, you get a version written for you, drafted by software and checked and signed by your clinician, alongside the technical report.
Hundreds of millions of CT scans are done each year for other reasons. Software could check each one for early lung, kidney, liver and pancreas changes, but only if a follow-up system exists.
Genetic test results for tumours are mostly PDFs. Require labs to also send a computer-readable version to a national store, so variants can be linked to what treatments worked.
The report that tells a patient their tumour's mutations should also tell them which trials are recruiting for those mutations within reach, with the status checked that week rather than copied from a stale list.
Rather than hitting the tumour as hard as possible, adaptive therapy uses just enough drug to keep it in check, letting drug-sensitive cells suppress resistant ones. A small prostate cancer pilot was promising; randomised trials are needed.
One faulty version of the p53 guardian protein can now be repaired by a drug that plugs a hole in it. Systematically hunting for similar holes in other faulty versions could help far more patients.
Immunotherapy antibodies stay active in the body for weeks, yet are often given every two or three weeks. After a few months, spacing doses out to every two or three months might work as well, with fewer hospital visits and much lower cost.
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.
Doctors rarely take a full family history. An app that gathers it from the patient and checks it against testing guidelines would find many people who qualify.
Combination trials usually keep one drug at full dose and push the other as high as patients can bear. Testing a grid of dose pairs would find combinations that work at lower, safer doses.
Many healthy people of African descent have naturally lower white-cell counts because of a common genetic variant. Trials use a single cut-off that wrongly labels them unfit, so they are turned away. The rule should be adjusted for this variant.
Trials stop following patients after a few years, so late side effects and late relapses are missed. Link trial participants to national records so follow-up continues automatically for decades.
The person looking after a cancer patient at home is assessed, trained (medicines, symptoms, when to call) and supported as part of the plan, not left to work it out.
Family doctors often do not know who is responsible for a cancer patient's blood pressure, diabetes or new symptom. Written agreements plus a same-day electronic question line to the oncologist would fill the gap.
If a blood test reliably shows whether cancer will come back after surgery, trials could use it instead of waiting years for relapse. Regulators have a process to bless such a test; oncology should use it.
When a treatment stops working, the tumour is rarely re-sampled, so nobody learns why. Paying for a biopsy at that moment would build the missing map of resistance.
Patients are more likely to join a trial when the doctor offering it looks like them or works in their community. Funding more such doctors to become trial leaders would change who is enrolled.
Wikipedia is the most-read medical reference on Earth. Pay expert editors to keep its cancer pages accurate, current and available in the languages most patients speak.
The evidence for old drugs against cancer is scattered across hundreds of papers. Assembling it into the format regulators and funders need is cheap and would speed decisions.
Instead of a review that is out of date on publication, fund teams to keep one continuously updated review per cancer setting, adding each new trial as it appears.
Almost no money is spent checking whether important cancer findings hold up. Setting aside a small fixed fraction of every research budget for replication would change that.
A drug that improves appetite and lean weight in cancer wasting is approved in Japan but almost nowhere else. Reviewing the existing evidence could widen access quickly.
Several studies found patients infused with checkpoint inhibitors earlier in the day lived longer. If a randomised trial confirms it, it is a free improvement available everywhere tomorrow.
Many women who died of ovarian cancer were never tested for BRCA. Testing their stored tumour samples and contacting their relatives would find carriers before they get cancer.
Rare cancers often share a broken cellular machine even when they arise in different organs. Grouping patients by that shared fault makes trials possible.
Spain lets hospitals make and use their own CAR-T under a special rule; most European countries do not. A common rule with shared outcome tracking would spread affordable academic products.
Serous endometrial cancers often overproduce HER2. Enhertu already works in them; testing HER2 in every p53-abnormal tumour and using the ADC earlier could change outcomes for the worst subtype.
Most people in poorer countries die at home without any professional support. A simple kit of medicines and supplies plus a few hours of training for a family member could make dying far less painful.
Once a patient has safely had the first few doses of a trial drug at the hospital, later doses could be given at home or a local clinic, with blood tests done nearby, so distance no longer decides who can join.
Frail women over 80 with small hormone-sensitive breast cancers may do as well with a daily tablet as with surgery. A trial would define who can safely avoid the operation.
Academic hospitals can already make CAR-T cells for a fraction of the commercial price. A public network would scale that so more patients can be treated for less.
European law already lets hospitals make advanced therapies for their own patients. Pair that with a shared outcomes registry so academic CAR-Ts and similar treatments can prove themselves without a commercial licence.
Because cervical tumours carry viral DNA that normal cells do not, a blood test for HPV DNA is a near-perfect tumour marker for tracking response and relapse.
Use immunotherapy to shrink liver cancer enough for a transplant, and find the safe gap between the last dose and surgery so the new liver is not rejected.
A rice-grain-sized implant can release small doses of many different drugs into separate spots of a tumour, then be removed so doctors can see which one worked in that person.
Some new medicines reprogramme immune cells inside the body with an injection, skipping the factory entirely. Test whether that makes CAR-T affordable and available in ordinary hospitals.
In the first weeks after diagnosis, tell patients plainly what kinds of false claims and expensive unproven clinics they will encounter and how to spot them.
Whole regions of tissue carry cancer mutations long before a tumour exists. Detecting and treating the field, not the tumour, could prevent cancers rather than cure them.
Most cancers have the wrong number of chromosomes; normal cells do not. If that difference creates a specific weakness, a drug against it would spare normal tissue by definition.
Before a company runs its big trial, all the major regulators should agree together on the design in one meeting, so the same trial can be approved everywhere.
Papers say 'data available on request' or link to files that no longer exist. Journals should verify data access at publication and periodically afterwards, and mark papers whose data have disappeared.
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.
Instead of trying to kill every hidden cancer cell after surgery, keep them dormant for life with low-toxicity drugs, the way extended hormone therapy already does in breast cancer.
A trained non-clinical guide who explains trials, arranges logistics and keeps in touch could make the difference between a patient hearing about a trial and actually joining one.
Teenagers with cancers that are really adult cancers, like melanoma or sarcoma, are barred from adult trials by an age line at 18. Letting them in from age 12, where biology and dosing allow, would give them access years earlier.
When someone tests positive for a BRCA or Lynch mutation, relatives are told only if the patient passes the message on. Most do not. Letting clinics contact relatives directly, with consent, could double testing.
Only the manufacturer can ask regulators to add a new use to a drug's label, and generic makers have no reason to. Universities and charities should be allowed to apply.
As results come in, the trial sends more new patients to the arms that are working and fewer to those that are not, so more people benefit and bad arms die faster.
Companies extend monopolies on cancer drugs with dozens of minor patents and deals that pay generic makers to stay out. Closing these loopholes would bring cheaper versions years earlier.
Millions of people have had weight-loss surgery or now take weight-loss drugs. Linking those records to cancer registries would show, cancer by cancer, how much reversing obesity prevents, for almost no cost.
The detailed molecular maps of tumours being built today mostly lack information on what happened to the patient. Require every atlas sample to carry consented outcome data.
Hospitals rarely know what fraction of their patients got the recommended treatment. Software reading the electronic record can show each team, every month, where care deviated from guidelines.
Cancer treatment guidelines would be updated continuously and published in a form computers can read, so hospital systems, apps and decision tools update themselves the day the evidence changes.
For each question patients actually ask, keep a short, current, sourced answer in plain words, updated as evidence changes and available in the languages people speak.
Before testing a drug in people, someone should systematically gather all the animal and laboratory evidence, including the studies that failed. Almost no cancer trial does this.
Cancer treatment guidance changes constantly and takes years to reach many clinics. Make guidelines live documents that software can read, updated as evidence arrives and adapted to what each country can afford.
Companies sometimes choose the biomarker threshold that makes their trial look best after seeing the data. Requiring the threshold to be fixed and published before the big trial starts prevents this.
A cheap blood pressure drug may soften the dense scar tissue around pancreatic tumours so chemotherapy and immune cells can get in. Early trials look encouraging.
Cervical cancer cannot be cured by external radiotherapy alone; it needs internal radiation, which many hospitals lack. A cheaper internal-radiation unit using a long-lived source could be placed in every regional centre.
A 5 mg tamoxifen dose halves breast cancer recurrence after precancer with far fewer side effects than the full dose. Almost nobody is prescribed it. Change who can prescribe.
The FDA now asks companies to find the right dose of a cancer drug before approval. If every regulator asked the same way, companies would do it once and doses would match worldwide.
Most cancer patients are over 65 and many have other illnesses, yet trials routinely exclude them. Regulators should require sponsors to justify each exclusion, so the evidence matches the patients.
Ninety-five percent of bowel cancers ignore immunotherapy. Combinations that heat the tumour up (targeted drugs, radiation, new checkpoints) are the main hope.
New operations and surgical devices spread by enthusiasm, not evidence. Every new technique would have to be entered in a registry that tracks patients through defined stages before it can be widely used and paid for.
Changing how a cancer drug is made must be approved separately in over a hundred countries, which takes years and causes shortages. One approval should count for all.
Blood levels of oral cancer pills vary several-fold between people on the same dose, so some are under-treated and others poisoned. Checking levels and adjusting the dose, as is routine for some antibiotics, could fix both.
Focused ultrasound can break a tumour apart without heat or cuts, leaving debris the immune system can learn from. Doing that to one tumour may help treat the rest.
Companies can license their patents to generic makers for poorer countries through a UN-backed pool, as happened for HIV. Only one cancer drug has been licensed so far; the whole essential list should be.
Infant leukaemia is driven almost entirely by KMT2A fusions, which menin inhibitors were built to attack. Add them to the new blinatumomab-containing backbone.
Stool transplants from immunotherapy responders have rescued some non-responders in melanoma. If defined bacterial cocktails work as well, every immunotherapy patient could get one.
Cancer charities would fund companies to hit specific development milestones, as the cystic fibrosis charity did to create Kalydeco, and take a royalty they reinvest in the next drug.
Vans equipped with ultrasound, biopsy kits, cervical screening and a link to a distant pathologist could bring a cancer diagnosis, and for cervical pre-cancer immediate treatment, to villages far from any hospital.
People differ several-fold in how they absorb and clear cancer pills. Measure blood levels and adjust each person's dose, as is routine for some antibiotics and transplant drugs.
SERENA-6 showed you can act on a blood test before the scan changes. The same logic could apply to PIK3CA, AKT1, or HER2 mutations emerging on treatment.
Several drugs are approved for the same cancer, but nobody tests which order works best because no company benefits from the answer. Public multi-arm trials could settle these questions efficiently.
Instead of one lab's mouse study deciding whether a drug goes to patients, several labs run the same protocol independently, like a multi-centre clinical trial for mice.
Factories making living or radioactive cancer medicines are inspected separately by each country. Accepting each other's inspections would free up inspectors and speed supply.
Give immunotherapy before surgery rather than after, so the tumour is still present to teach the immune system, then look inside it to learn what happened.
About one in a hundred people who develop diabetes after 50, more if they are losing weight, have pancreatic cancer. A simple score could send them for a scan or blood test.
Regulators should refuse to approve a two-drug combination unless there is evidence that both drugs are doing something, so patients are not exposed to useless extra toxicity and cost.
Thousands of papers extract 'radiomic' features from scans to predict outcomes, but the features change with scanner settings. Journals should require standard compliance before any clinical claim is made.
The engineered virus that delivers the CAR gene costs tens of thousands of dollars per patient and is controlled by a few suppliers. A non-profit supplier with open licences would cut that cost sharply.
Putting the CAR gene into T cells without a virus removes the most expensive and delay-prone ingredient. Test whether non-viral products match viral ones.
Almost every pancreatic cancer shares one of a handful of KRAS mutations. A pre-made vaccine against them could be given to every patient after surgery.
Blood tests for bowel cancer miss most precancerous polyps, so they should not replace stool tests. But for the third of people who never do any screening, a blood test may beat nothing.
A phone app that works without internet and guides a general doctor or nurse through diagnosing and treating common cancers with the drugs actually available locally.
Manage fevers, dehydration and other treatment side-effects at home with visiting nurses, wearables and video, instead of admitting people to hospital wards.
Let specially trained cancer pharmacists prescribe anti-sickness drugs, growth-factor support and routine dose adjustments under protocols, freeing oncologists for decisions only they can make.
Interleukin-12 is one of the most powerful immune stimulants but is too toxic to inject into the bloodstream. A virus can be engineered to make it only inside a tumour.
Build and certify a single free tool that strips names and identifying marks from cancer scans and pathology slides, so every hospital stops writing its own.
Patients with brain tumours are sold ketogenic diets on the strength of mouse data and small feasibility studies. A single adequately powered trial with dietitian support would either prove it or let clinicians say clearly that it does not work.
There are several different PD-L1 tests, each tied to a different drug, and they disagree. A single digitally calibrated scale would let any lab's result be translated into any drug's cut-off.
Adding a new arm to an international platform trial currently needs approval in every country again. A single, pre-agreed process would let arms open in weeks.
Regulators want proof a drug works; payers want proof it is worth the price. Agreeing both requirements at once would stop drugs being approved but then not paid for.
Companies must agree separate plans for testing new cancer drugs in children with US and European regulators. A single agreed plan would get children access sooner.
Rare cancers are collectively common but each is too rare for normal trials. Link every rare cancer patient worldwide into one network with registries and trial designs built for small numbers.
Medical physicists, who keep radiotherapy machines accurate and safe, are scarcer than oncologists in many countries. Remote quality checks with local technologists could let one physicist safely oversee several machines.
Japan and China have often required extra local studies before accepting a global trial. Committing to accept well-designed global trials would bring drugs to Asian patients years earlier.
Contract negotiation between a hospital and a drug company often takes longer than the trial's first patient. A single pre-agreed contract and budget template, used by everyone, would cut months off opening a trial.
Many research antibodies do not actually bind what the label says. Independent testing against cells lacking the target can prove it, and journals should require that evidence.
A registry-in-a-box would be a free, ready-to-run cancer registry system, working on phones and without constant internet, so any hospital anywhere can start counting and following its cancer patients.
Publish the exact rules used to work out from messy hospital records which treatment a patient was on and when it stopped working, and test them all on the same data.
Instead of paying hundreds of thousands up front for a CAR-T or gene therapy, the health system would pay in yearly instalments that stop if the cancer comes back, so companies are paid for cures, not attempts.
Before a trial is finalised, a paid panel of patients and community members from the groups the trial needs would review it and could require changes to visit schedules, procedures and materials that would deter people like them.
Train and pay people who have been through cancer to guide newly diagnosed patients through the system, especially where oncologists and nurses are scarce.
Instead of excluding sicker patients entirely, trials would run a side group for them, receiving the new drug with closer monitoring, so we learn how it behaves in the people who will actually get it.
Fund trials of old, cheap drugs with anti-cancer signals without seeking patents, and have generic makers produce them, so cost, not profit, decides whether patients get them.
Much of a pathologist's day is preparation, measuring and describing specimens. Trained assistants can do that, and AI can pre-screen slides, so each pathologist reports far more cancers.
Before a trial is funded, patients who have had the disease sign off on how many visits, scans and blood draws it demands, and on whether the endpoints measure things that matter to them.
Patients would carry a digital consent that says how their trial samples and records may be reused, so their contribution is not locked to one company or study and they decide who benefits from it.
When a trial fails, the company has little commercial reason to keep the detailed data secret. Make sharing it the default rather than something researchers must beg for.
At each point where treatment is chosen, software checks the patient's record against open trials and the clinician must note which were discussed, so trials stop being something only some people hear about.
Resistant cancer cells sometimes come to depend on the very drug they resisted. Stopping the drug for a while can make them vulnerable to it once more.
Insurers pay for many cancer tests that have never been shown to improve outcomes. Paying only inside studies that measure whether the test helps would sort the useful from the useless.
A single cell therapy can cost more than a house. Paying in yearly instalments, only while the patient stays well, spreads the cost and shares the risk.
Governments and donors should buy guaranteed working hours from radiotherapy vendors, with remote monitoring and regional spare-parts depots, instead of buying machines that then sit broken.
A large trial showed a structured exercise programme improved survival after bowel cancer. Almost no health system pays for it, so almost no patient gets it.
For very expensive one-time treatments such as CAR-T, pay in instalments over years and stop paying if the cancer comes back, so price tracks the cure actually delivered.
Health insurers and national health systems have every reason to find out whether half the dose or half the duration of a costly drug works as well. They would fund those trials directly and keep the savings.
Surgery stress may help hidden cancer cells spread. A five-day course of two cheap old drugs around the operation might block that, and small trials look promising.
Vaccines tailored to each patient's tumour mutations are showing real benefit but cost a fortune to make. Automate the whole process so a personalised vaccine costs about as much as a course of chemotherapy.
Bowel screening uses one blood-in-stool threshold for everyone. Setting it by age, sex and the person's previous results would find more cancers with the same number of colonoscopies.
Custom cancer vaccines take weeks to make and work best when there is very little disease. Making one at surgery and giving it when a blood test turns positive matches both facts.
Dogs get cancers that closely resemble human ones, with real immune systems and years of natural history. Treating them, with owner consent, can test drugs in a way mice cannot.
Cancer pills interact with many common medicines for heart, stomach and blood conditions, sometimes dangerously. A pharmacist check before starting, and at each refill, would prevent avoidable harm.
Mouth ulcers and loss of taste from chemo and radiotherapy stop people eating. Low-level light therapy and structured swallowing and taste rehabilitation can help; make them standard.
Most of the world's cancer patients live in countries that host almost no registrational trials. Including sites there, and paying to build them up, would make results apply globally and speed local access.
Cell therapies fail when the tumour stops showing the marker they were built to find. Preparing an alternative product in advance would let doctors switch quickly.
Many antibody-drug conjugates share the same linker and payload chemistry. Regulators should let companies reuse the manufacturing evidence rather than repeating it for every new antibody.
When two accepted treatments are equally reasonable, the computer system would offer to randomise the choice and track the result, turning ordinary care into a continuous trial.
Buy essential cancer drugs for many countries at once and license newer ones to generic makers, as was done for HIV, so prices fall to what those health systems can pay.
For a frail 80-year-old, staying independent may matter more than living a few months longer. Trials designed for older patients should measure what they care about.
Patients join a long-term cohort once and agree in advance that they may be offered new treatments as they appear, while others in the cohort serve as the comparison group. No new trial has to start from zero.
AI systems claim to find new uses for old drugs, but their predictions are rarely tested fairly. Publish their cancer predictions in advance and score them against trial results.
When control-arm patients switch to the new drug after their cancer grows, the survival comparison gets muddied. Trials should plan in advance how they will correct for this, and report both raw and corrected numbers.
Many mouse experiments use so few animals that the results are unreliable, and papers show one 'representative' result out of several tries. Funders should require proper sample-size planning.
Men on surveillance for prostate cancer have repeat biopsies every year or two, which puts many off. Using MRI, PSA density and new markers to trigger biopsy only when needed could be just as safe.
A large share of cancer research has been done on cells that were mislabelled or contaminated. A cheap DNA fingerprint test can prove identity; journals and funders should require it.
Drugs approved on early signs of benefit are paid for as if they had proved they extend life. Pay a provisional price and adjust it, up or down, when the survival data come in.
Building a cell-therapy factory costs tens of millions, so most good academic ideas never reach patients. Shared public facilities would give them a route to the clinic.
Anyone building a new test for HER2, PD-L1 or tumour DNA should be able to check it against the same public reference set. Today each developer validates on private data nobody can inspect.
Hospitals in Spain make their own CAR-T for a third of the commercial price. Paying for such products at cost gives health systems a lever in negotiating with companies.
There is no agreed ruler for measuring how strong a CAR-T product is. Shared reference materials would let hospitals, companies and regulators compare products fairly.
Cheap, essential chemotherapy drugs such as cisplatin keep running short because there is little profit in making them. A publicly-backed non-profit manufacturer would guarantee supply at a fair price.
India has shown CAR-T can be made for a tenth of the US price. Public production in large middle-income countries could make it available to millions who are currently excluded.
Labs already get tested on whether they score biomarkers correctly, but the results are private. Publishing them would let hospitals and patients avoid labs that get it wrong.
When a regulator rejects a cancer drug, the reasons are usually secret. Publishing them everywhere would stop other countries and companies repeating the same mistakes.
Trials often have independent radiologists check whether tumours grew. How often they disagree with the treating doctors is a measure of how trustworthy the result is, and it is rarely published.
Current blood tests miss leftover cancer in many patients. Reading thousands of mutations at once, rather than a few dozen, can detect far smaller amounts.
Cell therapies made from a single stem cell line could be produced in bulk. Regulators should let companies certify the parent cell line once rather than repeating it for every product.
PSMA scans could measure prostate cancer burden and response far better than PSA, but no one has done the standardisation work to make the measurement trustworthy across scanners.
Before a big trial starts, ask hundreds of patients how much extra survival they would trade for a given side-effect, so the trial is designed to test something patients would actually want.
Half of cancer patients need radiotherapy and most of the world cannot get it. Commit to low-cost machines, automated planning and trained staff so that access is universal by 2040.
National cancer registries already collect the outcome data. Adding a randomisation button lets doctors compare two standard treatments across thousands of patients at a fraction of the usual cost.
Rare cancer patients are already tracked in registries. Offering randomisation inside the registry makes trials far cheaper and lets almost anyone take part.
Many cancer drugs are approved at the highest dose patients could stand, not the best dose. Run trials that test lower doses on approved drugs and measure how patients feel.
Fund proper trials of the methods used to get new evidence into practice (training, reminders, feedback, incentives), measured by whether patients actually receive the better treatment.
Many patients are denied a drug because a test says they will not benefit. For the most important tests, that assumption should itself be tested in a trial.
Treatment is often chosen from a biopsy taken years earlier from the original tumour. The spread disease may now look different. Test it again before switching drugs.
Surgeons often cannot see where a tumour ends. Fluorescent dyes and AI-read imaging in the operating theatre can show them, cutting repeat operations. Make this routine everywhere.
Track how much of each cancer drug patients actually receive and how often they need to reduce it, and use that to change the official dose when the label is too high.
When a trusted regulator approves a cancer drug for a rare genetic target, other countries should recognise that approval within months instead of repeating years of review.
Cancer drugs are often prescribed outside their approved use based on hope or small studies. Capturing outcomes of these uses would reveal which ones fail so they can be stopped.
Thousands of old radium sources sit in hospital and industrial storage. They are exactly the raw material needed to make actinium-225, the scarcest cancer isotope.
The dose needed to shrink a tumour may be higher than the dose needed to keep it from growing back. Trials that lower the dose once a response is achieved could reduce long-term side effects without losing control.
Actinium-225 can be made in particle accelerators, but the product contains a trace of a long-lived impurity that regulators have not agreed how to handle. Settle the limit and build the hubs.
Radioactive cancer drugs decay while they travel and get stuck at borders. Regional production and simpler transport rules would get more doses to patients on time.
Build a handful of publicly-funded centres where academic discoveries can be manufactured to clinical grade and written up for regulators, so good ideas do not die for lack of a factory and a filing.
Journals agree to publish a study based on the quality of the question and plan, before anyone knows the answer. That removes the pressure to make results look positive.
Use the cancer registry itself as the trial machine: randomise patients at diagnosis, then let the registry collect the outcomes for a fraction of the usual cost.
Much of trial screening is paperwork, questions and reviewing scans that already exist. Doing this by video and electronic consent before any travel would let patients decide without a wasted trip.
People with cirrhosis are meant to have ultrasound scans twice a year, but most do not. A blood test done with their routine liver bloods could catch liver cancer earlier.
Tumours fill with immune cells that protect them. Earlier drugs tried to remove those cells and failed. Newer ones aim to switch them to the attacking side.
Many large trials are launched on the strength of a small study with no comparison group, and most of those large trials fail. Insisting on a smaller randomised comparison first would filter out weak drugs earlier.
The big metformin cancer trial failed after years and millions, despite strong observational hints. Cheaper checks on causality should be passed before funding the next one.
AI for screening should be judged on whether it finds dangerous cancers earlier and misses fewer, not just on whether it agrees with radiologists on old images.
Trials that fail still collected thousands of blood and tissue samples. Instead of being destroyed, they should be pooled so scientists can learn who might have benefited.
Immunotherapy is given as one flat dose regardless of body size, which means smaller patients get more than they need. Dosing by weight would save a fifth of the drug at no cost to patients.
The traditional way of finding a dose looks only at severe side effects in the first month. Modern statistical designs can use all patients' data and count the grumbling, long-lasting problems that make people quit months later.
Cancer survivors are a huge and growing population with specific long-term risks. Give each a plan matched to their risk, run automatically and shared with their family doctor.
Pumping drugs slowly through fine tubes into a brain tumour can bypass the barrier, but the fluid often leaks away. Robotic placement and live scans would show where it actually goes.
Hospitals without enough physicists could upload scans to a shared planning centre, where AI drafts the treatment plan and remote experts finish and check it within a day.
Software can already spot impossible statistics, mismatched p-values and duplicated images in a paper. Journals should run these checks on every submission, as spell-check runs on every document.
Instead of testing a drug in lab models first and hoping the results carry over, build the same models from trial participants and run both experiments in parallel to see how well the models predict.
The US government already runs a small programme that turns academic cancer discoveries into drugs ready for human trials. Scale it up tenfold and copy it in other countries.
Cancer costs push patients into debt and make them skip treatment. Asking about money at every visit, and having someone to help, catches this before it does harm.
Cancer often ruins families financially, and money worries make people skip treatment. Ask about finances at the first visit, as routinely as asking about allergies, and route people to assistance.
Ask about money problems with a short validated questionnaire when treatment starts, and route those at risk to financial navigators before bills cause missed doses.
Keep test datasets locked away and collect them going forward, so AI claims are checked on data the developers have never seen and could not have memorised.
Instead of every woman every two or three years, an AI reading of the current mammogram would set who comes back in one year and who can safely wait four.
Each trial would set its target mix of patients from cancer registry data on who gets that cancer, by age, sex and ethnicity, and show a public running tally so gaps are visible while there is still time to fix them.
When five companies each run a trial against the same standard treatment in the same patients, let them pool the standard-treatment patients so fewer people are randomised to the old drug.
Personalised cancer vaccines and cell therapies need a factory for each patient. Shared, automated production units serving many academic hospitals would let universities run these trials without building their own plants.
Before a trial is finalised, run its entry rules against records of real patients with that cancer and report what fraction would qualify. If it is under half, explain why.
Cancer units in poorer countries lose treatment days, spoil drugs and damage machines during power cuts. Solar panels with batteries sized for the cancer unit would remove that failure point.
When a trial has no comparison group, the comparison is sometimes built from old patient records. Set rules for how that is done so the answer is not rigged.
Instead of starting everyone on the full dose and cutting back after side effects, start lower and increase in patients who tolerate it. This keeps more people on treatment and is how blood-pressure drugs are given.
Having had another cancer years ago, or living with well-controlled HIV or hepatitis, still keeps many people out of trials for no good scientific reason. Removing these blanket bans would widen access, especially in communities where these conditions are more common.
People with Barrett's oesophagus without dysplasia have endoscopies every few years, but the BOSS trial found no survival benefit. Redirecting effort to those with dysplasia would save harm and cost.
Screening someone unlikely to live ten years causes harm without benefit. A life-expectancy estimate in the medical record could stop invitations and prompt a conversation.
Instead of waiting months for a company to package trial results, regulators would see the data flow in during the trial and could decide within weeks of it ending.
Cancer cells in the blood wrap themselves in platelets as camouflage. Aspirin may remove that cloak, and it is cheapest to test in the patients at highest risk of relapse.
Older cancer patients often take ten or more medicines, some of which no longer help and may interact with cancer treatment. A pharmacist review to stop unnecessary ones, at diagnosis and when goals change, would reduce harm.
Surgery cures more cancers than any other treatment, but most district hospitals refer everything to a distant centre. Train and mentor general surgeons to do common cancer operations well, with specialists checking results.
Radiologists would record tumour measurements and response in tick-box, coded form rather than prose, so progression is machine-readable across every scan.
Instead of paying per dose, a country would pay a fixed annual fee and treat every eligible patient with immunotherapy. This has worked for hepatitis C drugs and antibiotics.
Every patient finishing treatment should get a clear document listing what they had, what to watch for, and when to be checked. Software can write it from the record so it actually happens.
With Enhertu and tucatinib controlling brain metastases in most patients, radiation could be reserved for those who do not respond, sparing cognitive side effects.
Survivors who had chest radiotherapy as young women, or certain chemotherapies, have much higher risks of specific second cancers. They should be screened like people with inherited risk, and today most are not.
Transferring gut bacteria from patients who responded to immunotherapy has helped some patients who had stopped responding. It is time for a proper large trial.
People who eat more fibre appear to respond better to immunotherapy, while some probiotic supplements may do the opposite. A proper trial would settle it.
For very rare cancers there is often no genetic clue and no trial. Growing the patient's cells and testing drugs on them directly can suggest what to try.
Many antibody drugs moved from doses based on body weight to one fixed dose for everyone, which is convenient but means lighter patients get relatively more drug. Trials comparing the two, plus rounding doses to standard vial sizes, could keep effectiveness while cutting cost and waste.
Giving a targeted drug in pulses rather than continuously might slow the emergence of resistant cells and reduce side effects. Early results are mixed, so this needs careful trials with clear rules for when to try it.
Trials that only enrol patients with a positive biomarker can never prove the biomarker matters. Including a smaller biomarker-negative group would show whether the test is really needed.
New cancer drugs should have to prove not only that they extend life but how they affect how people feel and function, with that result printed in the label like efficacy.
Ultra-sensitive whole-body scanners can measure exactly where a radioactive drug goes at tiny tracer doses, allowing each patient's therapeutic dose to be tailored.
Give the nurses and pharmacists who take patients' calls a tool that walks them through recognising and managing side effects of modern cancer drugs, including when to escalate.
Give oncologists and cancer nurses the training, time and production support to reach people where they actually get information, on social video and podcasts.
Online patient groups are where much cancer advice is exchanged. Fund and train moderators, with quick access to reliable evidence, to keep those spaces accurate and kind.
The wasting that kills many cancer patients has had no effective drug. New antibodies against GDF-15 restored weight in early trials. Combine them with exercise and nutrition and test properly.
Wasting kills many cancer patients and makes treatment impossible. With the first effective anti-cachexia drug in phase 3, the next question is whether starting it early prevents wasting rather than reversing it.
Immune side-effects are usually treated with high-dose steroids, which may also switch off the anti-cancer response. Targeted alternatives may control the side-effect and keep the benefit.
Intracavitary immunotherapy targets cancer that coats the lining of the abdomen or chest, which drugs given by drip barely reach. Delivering it straight into the cavity gives far higher local doses.
The first lymph node cancer reaches is also where the immune system learns to fight it. Injecting immunotherapy into that node before surgery, instead of removing it blindly, may work better.
When an oncologist opens the order screen to prescribe a new line of treatment, the record would show the trials this patient may fit, with the nearest open site and a one-click referral.
Many people report foggy thinking and memory problems for years after chemotherapy, and almost nothing is offered for it. Structured brain-training and coaching programmes deserve proper trials.
Highly unstable tumours survive constant chromosome mistakes by leaning on a motor protein. Blocking it kills unstable cancer cells while sparing normal ones.
Injecting immune-activating agents into a single tumour, plus a small dose of radiation, can teach the immune system to attack tumours elsewhere in the body.
Whether immune cells are next to cancer cells matters more than how many there are. Turning that spatial picture into a reliable, standardised test would predict response better.
CAR-T can now be made in a day or two, but the safety tests to release it still take two weeks. Faster tests would let patients be treated within days.
Give patients a short course of one of several drug pairs in the gap before surgery and compare what happened inside the tumours. It is the fastest human test of whether a combination does anything.
Brain tumours shed very little DNA into blood, so a sonobiopsy briefly opens the brain's barrier with focused ultrasound to release enough to read from a blood sample.
Low doses of drugs that change how DNA is packaged can make cancer cells display more of what marks them as abnormal, potentially waking up immunotherapy in cold tumours.
The pre-built treatment menus in hospital computers often stay unchanged for years. Require them to be updated within a month of any guideline change, using the machine-readable guideline feed.
Frail older patients are often given full doses and then have them cut after bad side effects, or are given nothing. Trials should test starting at a lower dose from the beginning.
Tumours starved of oxygen produce a chemical that switches immune cells off. A scan can show which tumours are starved, and those are the ones to treat with blockers.
Common gene variants shift a person's cancer risk several-fold. A one-time genetic score could tell each person when to start breast, bowel or prostate screening.
Some cancer pills are absorbed several times better with food, but the label says take them fasting at a high dose. Taking a quarter of the dose with breakfast can give the same drug levels at a quarter of the price.
Low doses of anti-blood-vessel drugs briefly make tumour vessels work better, which helps immune cells and other drugs get in. Scans can find that window for each patient.
If a blood test shows no tumour DNA after months of treatment, a trial could test pausing the drug and restarting only when the DNA reappears, giving patients time off without waiting for scans to show growth.
Personal cancer vaccines target many mutations, some of which are present in only part of the tumour. Aiming only at mutations every cell shares should stop the tumour escaping by losing them.
Indian trials have shown that tiny daily doses of old oral chemotherapy drugs can help patients with head and neck cancer at a cost of a few dollars a month. These regimens should be proven and adopted worldwide.
Real-world studies say a drug 'stopped working' based on clinic notes. Check how often that matches a proper scan review, and fix the definitions so the two agree.
Pragmatic trials want to use the progression dates recorded in ordinary clinic notes instead of expensive protocol scans. Checking how well those routine records match formal trial measurements would show when that shortcut is safe.
AI is starting to decide which patients get which cancer drug. Every change to the software should be tested against a fixed public set of cases before it is used on patients.
Many survivors of working age lose their jobs or income after treatment, though they could work with the right support. Job-focused rehabilitation should be part of cancer care, as it is for stroke.
Some everyday medicines, such as antibiotics or steroids, seem to blunt immunotherapy. Automatically scanning health records for such harmful pairs would catch them years earlier.
Most kidney tumours under 3 cm found by chance grow slowly and a fifth are benign. Watching them, with surgery only if they grow, could spare many operations.
When immunotherapy works, specific immune cell families multiply in the blood within weeks. Tracking that could tell patients early whether to continue.
Step counts and sleep from a wristband could show whether a cancer treatment is helping or harming daily life. Prove they track survival and quality of life, then use them in real-world studies.
In many tumours the immune cells are present but cannot get in. If we knew the dominant barrier, we could open the gate and make immunotherapy work for more people.
A positive blood test tells you cancer is back but not where. Combining whole-body MRI with modern PET tracers may find a single spot that can be zapped.
Cheap copies of key antibody drugs exist but many countries cannot check their quality. A WHO quality stamp plus large pooled orders would make them safe to buy and very cheap.
People with an inherited TP53 mutation face a near-certain lifetime cancer risk. Yearly whole-body MRI catches cancers early; adding blood DNA tests may catch them earlier still.
Volatile compounds in breath differ in cancer. A breath test validated in truly symptomatic patients, not lab volunteers, could tell GPs who needs urgent scans and who can safely wait.
Nearly all cancer drugs are found by killing fast-growing cells. Sleeping cells survive them. A screen designed around dormant cells would find a different class of drug.
Tests for 'HRD', which decide who gets PARP inhibitors, rely on genomic scars that reflect the tumour's past, not its present. A test of current DNA-repair function would be better, but needs standardising.
Before any academic compound gets money for pre-trial studies, it would have to show activity in a standard panel of patient-derived tumour models run by an independent centre, so weak candidates are stopped early.
Nerve damage from taxanes and platinum is common, often permanent and has no approved preventive. Test the most promising candidates head to head in one programme.
Build a large, openly shared dataset of how tumour organoids respond to drug pairs, so that anyone can look up which combinations might work for which tumour type.
Some tumours change fast and escape drugs quickly; others are stable. A single validated score for how evolvable a tumour is would tell doctors how aggressively to combine treatments.
For each cancer-causing mutation, find every gene the cancer cell newly depends on, in every tissue, so that even undruggable drivers get druggable partners.
Pancreatic cancer is often visible in hindsight on earlier scans. Software trained on those pre-diagnostic scans could flag subtle changes while surgery is still possible.
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.
When a tumour evolves resistance to one drug, it sometimes becomes weaker against another. Map these trade-offs systematically so doctors can pick the next drug to exploit them.
Cancer's most important drivers, such as MYC and mutant p53, cannot be blocked with normal drugs. Pool effort and share results openly to build molecules that destroy them instead.
Build a shared, openly available AI model that has learned how cancer cells respond to genetic and drug perturbations, so any lab can predict what a new drug or combination might do.
Most cancer proteins have never been tested to see whether a small molecule can attach to them at all. A public map of what is chemically reachable would tell the field where to aim.
You cannot study a cancer without a laboratory model of it, and most rare cancers have none. A funded bank that makes and shares models would unlock research.
Map every state a cancer cell can be in, and how drugs and the surrounding tissue move it between states, into an open computational model anyone can query and improve.
For many rare cancers there is not a single laboratory model in the world, so no one can test drugs. A shared bank with free distribution would change that.
A powerful immune-suppressing signal called TGF-beta keeps immune cells out of tumours, but blocking it throughout the body causes heart and skin problems. Tethering the blocker inside the tumour could give benefit without the harm.
Cells chop up their internal proteins and display the pieces on their surface. That means even undruggable proteins inside the cell can be attacked from outside by the immune system.
Many aggressive tumours keep their cancer genes on free-floating DNA circles that let them dial resistance up and down at will. Drugs that break the circles or the cell's tolerance of them are a new frontier.
There are far more possible drug combinations than can ever be tried in patients. Test thousands on living samples of real tumours, then feed only the winners into adaptive trials.
Hospitals usually keep one piece of a removed tumour. Keeping three pieces from different parts would show how varied the tumour is, at almost no extra cost.
Tag every cell in a patient's lab-grown tumour with a unique DNA label, give it a drug, and read the labels to see which cells survive. This predicts which resistant clone will emerge.
Drugs that grab T cells and drag them onto tumours work well in blood cancers. The same trick aimed at tumour-eating cells might work where T cells are absent.
Cells that survive treatment do so by changing which genes they use, not their DNA. Drugs that block that change may stop survivors from forming at all.
An old part of the immune system called complement can be hijacked by tumours to summon protective cells. Drugs that block it already exist for other diseases.
Cancer cells can survive a drug because surrounding normal cells feed them growth signals. Blocking those signals could make existing drugs work better and longer.
Surgery makes some immune cells throw out sticky DNA webs that trap travelling cancer cells and help them settle. Dissolving those webs during the operation might prevent some relapses.
Drugs that reach brain tissue may still fail to reach the fluid where cancer spreads along the linings. A lab model of that second barrier would let us screen for drugs that cross it.
Some tumours have broken the machinery that displays their identity to immune cells. Those patients cannot benefit from most immunotherapy and should be routed elsewhere.
Treatment leaves behind damaged cells that stop dividing but do not die, and they release signals that help surviving cancer cells regrow. Removing them could reduce relapse.
Ultra-fast FLASH radiotherapy and proton beams may spare healthy tissue dramatically, but the machines cost tens of millions. Engineer versions that any hospital can afford.
The poisons carried by antibody-drug conjugates are so toxic that only a few factories can make them, and they are booked years ahead. Making them in small continuous reactors would ease the bottleneck.
We do not know whether ultra-processed food raises cancer risk because it makes people fat, or because of something in the food itself. Feeding volunteers matched diets for a few weeks and measuring cancer-relevant biology can tell the two apart.
When attacked, cells switch on a survival programme that buys them time to adapt. Blocking that programme could turn a partial response into a complete one.
Some sarcomas in children are caused by two genes fused into one abnormal protein. That protein is the whole disease, but no drug binds it. Destroying it instead of blocking it could work.
The nerves at the top of the nose lead directly into the brain, bypassing the barrier. Nasal delivery of drugs, and even immune cells, has worked in animals.
Choose two treatments so that whatever the tumour does to escape the first, it becomes easier to kill with the second. The immune system is a good candidate partner.
New drugs that destroy cancer proteins are usually too big to enter the brain. Making much smaller versions could bring this approach to brain tumours.
In advanced prostate cancer, a shortened form of the hormone receptor loses the very part existing drugs bind to. A drug that destroys the whole protein would still work.
Cell therapy batches fail more often than any other medicine, partly because each patient's cells behave differently. Sensors and software that adjust the process in real time could rescue many of them.
Build a computer model of each patient's cancer that forecasts how it will respond to each treatment option, and prove it by writing the forecast down before the real result is known.
Some cancer proteins sit on the cell surface or float outside cells, where protein-destroying drugs cannot reach. A different trick can drag them inside to be broken down.
Some harmless bacteria naturally grow in the low-oxygen core of tumours. Engineering them to produce immune-activating drugs turns them into tiny factories inside the tumour.
Many relapses come from cancer cells that hid dormant for years. Find drugs that either force them awake so chemotherapy kills them, or keep them asleep for life.
Today's engineered T-cell therapies for sarcoma only work in the ~40-50% of people with one particular HLA type; new receptors for other HLA types would open them to everyone.
Protein-destroying drugs work by hijacking cellular waste-disposal machines. Using a machine that is mostly present in cancer cells would make these drugs safer.
Sleeping cancer cells hide in bone marrow where drugs cannot reach them. Pushing them into the bloodstream on purpose, then treating, might clear them.
Almost every alpha cancer therapy in development relies on one scarce isotope. Developing several alternatives at once would stop the whole field waiting on a single supply chain.
Drug tests normally use cells from the original tumour. Growing the rarer cells found in blood would test drugs against the cells that are actually travelling.
While patients are treated in a platform trial, their tumour cells grow in a dish and are tested against dozens of drug pairs. The pairs that win in the dish become the next arms.
Tumours that contain small immune structures resembling lymph nodes respond far better to immunotherapy. Inducing those structures on purpose could make cold tumours responsive.
Most cancer drugs are tested in mice with no immune system, then given to people who have one. Mice carrying the same patient's immune cells and tumour would be a fairer test.
Instead of making cell therapy from each patient's own cells in a factory, inject a particle that reprograms immune cells inside the body, made in bulk, so a dose costs thousands rather than hundreds of thousands.
The cells that survive targeted therapy change shape and become unusually dependent on an antioxidant enzyme, GPX4. Hitting them in that window might stop resistance before it evolves.
A few cancer cells survive treatment by going quiet rather than mutating. These survivors are unusually vulnerable to a particular kind of cell death, which a drug could trigger.
A drug aimed at a mutation present in every tumour cell works differently from one aimed at a mutation in only some cells. Test reports should say which is which.
Resistance mutations often exist in a tiny fraction of cells before treatment starts. A very sensitive test at diagnosis could find them and prompt a combination from day one.
Many cancer proteins work by touching each other over broad flat surfaces. Small pills cannot cover those, but ring-shaped peptides can, and some can still be taken orally.
Building a genetically engineered mouse for a specific cancer takes years. Editing genes directly in an adult mouse's organ can produce the same tumour in weeks.
Immunotherapy works in tumours that immune cells can enter and ignores those that shut them out. Systematically test ways to open up the shut-out tumours, measured with spatial maps.
Drug candidates are tested for shrinking tumours, almost never for stopping spread. A standard spread test would find anti-metastatic drugs we are throwing away.
Metabolic drugs keep failing because tumours switch fuels. Measuring what a patient's tumour actually eats, with tracers and PET, could pick the right metabolic drug for the right tumour.
New imaging shows where every cell type sits in a tumour slice. Using it to see which sub-populations are hidden from immune cells could explain why immunotherapy fails in parts of a tumour.
Screening finds cancers that would never have caused harm alongside dangerous ones. Pair every screening test with a test that says which is which, so people with harmless findings can safely watch and wait.
A decoy protein can bind MYC's partner and block it. Delivering the instructions for that decoy as mRNA in a fat nanoparticle avoids having to inject the protein itself.
A drug that works in one laboratory's mice often fails elsewhere. Running the key animal study across several independent laboratories first would catch this.
Donor immune cells that need no matching could be given as short courses to clear the few cancer cells left after surgery, when the target is smallest.
Knowledge about how cancers become resistant is scattered across thousands of papers and company files. Pooling it into one structured, public resource would let anyone see the pattern.
Chemotherapy leaves behind senescent cells that inflame tissues and help tumours relapse. A short course of senolytic drugs afterwards might reduce relapse and long-term side effects at once.
Engineered immune cells given by drip rarely reach brain tumours. Briefly opening the barrier with focused ultrasound at the right moment may let them in.
Radiation can alert the immune system, but too big a single dose destroys the very alarm signal it creates. Picking the right dose and schedule may be free extra benefit.
Several big projects have sequenced the same tumours at different times and places, but their data sit apart. Bringing them together with common analysis would show general rules of how cancers evolve.
Immunotherapy can trigger dangerous attacks on the gut, lungs or heart. Use blood, gut bacteria and genetic markers to spot who is at risk and act early.
A troubling share of published cancer experiments use cell lines that are contaminated or mislabelled. Requiring a simple identity check before publication would stop this.
Patients who happened to take common allergy pills during immunotherapy seemed to live longer in a large records study. A simple randomised trial would show whether the pills really help.
Every staging scan contains a precise measure of muscle mass that nobody looks at. Software could report it automatically and flag patients heading for wasting.
The liver is where bowel cancer most often spreads. Drugs delivered straight into the liver's blood supply could retrain its resident immune cells to reject arriving cancer cells.
Some drugs work by sticking two proteins together so one destroys the other. These are usually found by luck. A large systematic search, published openly, would find many more.
Robotic labs guided by AI that design experiments on tumour models, run them, read the results and design the next ones, around the clock, with every result published openly.
When Enhertu stops working, the next ADC should probably carry a different kind of payload, such as the tubulin inhibitors in Kadcyla or ARX788, rather than another topoisomerase drug.
If every lab had access to the same set of well-characterised tumour models, results could be compared directly instead of each lab using its own private models.
Many tumours carry an enzyme that keeps creating new mutations, feeding resistance. Blocking that enzyme while a targeted drug works could make resistance arrive later.
Cancer cells need stiff, cross-linked tissue scaffolding to settle and grow in a new organ. Blocking the enzymes that build it may stop new colonies taking hold.
New microscopes can measure dozens of proteins at once and map where immune cells sit in a tumour. These readouts could predict immunotherapy response, but every lab does it differently.
Cancer cells enter the blood mostly during rest, so a morning blood test may miss them. Sampling and dosing at the right hour may be a free improvement.
Today's T-cell-receptor drugs only work for people with one tissue type. Building versions for the other common types would roughly double who can be treated.
A thin slice of a tumour, kept alive for a few days, still contains the immune cells and scaffolding that lab-grown cells lose. Drugs can be tested on it directly.
Many people get a genetic result of uncertain significance, which cannot be acted on. Lab methods now let us test every possible variant in a gene in advance.
Targeted drugs briefly make cancer cells easier for the immune system to spot. Giving immunotherapy exactly in that window, rather than at the same time, may work better.
Certain vaccines and fungal sugars reprogramme the bone marrow so it produces more aggressive immune cells for months. That could be used before immunotherapy.
Insomnia therapy works well for cancer survivors and is barely offered. A trial that fixes sleep and then follows recurrence would test whether restoring the body clock changes the disease as well as the symptom.
Large drugs such as antibody-drug conjugates must cross vessel walls and travel through dense tissue. A chip with flowing channels and human tissue can measure how far they get.
Cells have an enzyme, PP2A, that removes the growth signals cancer relies on. Cancers switch it off. Drugs that switch it back on are an unusual and largely untried approach.
Under treatment stress, cancer cells switch on sloppy DNA copying that generates the mutations they need to survive. Blocking that machinery could stop resistance being invented.
Drugs that destroy proteins can hit healthy cells too. Attaching them to an antibody that only docks onto tumour cells would keep them where they are needed.
A single protein predicts whether a tumour will respond to DNA-damaging drug payloads. Measuring it could stop patients receiving a second drug of the same kind that will not work.
The brain has natural transport doors for iron. Attaching a key that fits those doors can smuggle large drug molecules in, a trick now working in Alzheimer's medicines.
Most cancer cells that spread die or sleep forever; a few grow into lethal metastases. Nobody can yet tell them apart, and doing so would show whom to treat after surgery.
Vaccines can now encode dozens of a tumour's mutations, but only a minority provoke useful T cells. Learning the rules would make vaccines smaller, cheaper, and stronger.
PARP inhibitors, platinum, and radioligand drugs can push pre-existing blood-cell clones toward leukaemia in a few patients. Predicting who could let us choose therapies more safely.
Tumour cells injected into transparent fish embryos grow in days, so several drugs can be compared in about a week, fast enough to help a patient who cannot wait.
A drug's label should say whether its dose was chosen by comparing several doses or simply by finding the most patients could tolerate. Doctors could then know how much room there is to reduce the dose safely.
Offer a large cash prize to whoever proves, in a rigorous trial, that a cheap existing drug helps people with cancer live longer. Prizes pull effort towards neglected problems.
Governments and foundations would pledge a very large prize, paid only when a treatment is shown to keep most patients with a currently incurable metastatic cancer alive and disease-free for five years.
Before cancer spreads, distant organs are changed to become welcoming. A test for those changes would show which organ is at risk while a person still looks cancer-free.
One in five cancers in the UK is first found in an emergency, usually late. Adding a cancer test to the blood already taken in A&E for over-60s with vague symptoms could catch some earlier.
Like an organ donor card, anyone with cancer could sign once to let their medical records and leftover samples be used for research, and change their mind at any time.
Every biobank negotiates its own legal agreement for sharing tissue, which takes months. A shared standard template, like Creative Commons for samples, would let tissue and data move in days.
Record cancer operations (with consent), link each video to the pathology report and the patient's recovery, and open the collection to researchers to learn what surgical technique actually works.
A positive leftover-cancer blood test leaves patients frightened and their doctors unsure what to do. A specialist clinic could give them a plan and a trial.
Cancer kills more people in poorer countries than HIV, TB and malaria combined, but has no global fund. A pooled fund for diagnosis, essential medicines and radiotherapy would change what ministries can afford to build.
Wasting and side-effects kill or stop treatment for a large share of patients but attract almost no dedicated funding. This would create a standing programme for them.
People with dementia who develop cancer are often either overtreated or written off, and decisions are made without them. A clear pathway for assessment, consent and treatment planning would improve both.
Around four in ten cancers are preventable with tools that exist now. This would fund the hard, unglamorous work of getting vaccines, screening and tobacco control to everyone, paid on results.
Each batch of cells used in an experiment would carry a small digital record showing when it was authenticated, tested for contamination, and how many times it had been grown, attached to the published result.
Investors will not back a single university drug because most fail. A fund that finances fifty of them at once in exchange for a small slice of each one's future royalties spreads the risk enough to attract capital.
The studies needed before a first human trial cost a few million and no grant pays for them. A dedicated fund would decide in weeks and take a small share of any future revenue.
Sometimes a progression biopsy shows exactly which drug would help, but it is licensed for another cancer and cannot be obtained. A standing pathway would fix that.
Many people never receive treatments already proven to work. Cooperative trial groups would have to spend a tenth of their budget testing how to close that gap.
Add a scored criterion to grant review that asks how much suffering the proposal addresses and how soon, judged partly by patients, and give it real weight.
Thousands of tests that could predict who benefits from a treatment are published and never validated. A fund would pay for the boring but essential confirmation studies in independent patient groups.
Create a proper, indexed journal that publishes failed experiments and trials quickly, with fees paid by funders so that there is no barrier to reporting failure.
Countries buying radiotherapy machines one at a time pay high prices and get poor service. A single global buyer negotiating for dozens of machines a year could cut prices and demand long-term support.
Academic first-in-human trials recruit slowly because each hospital repeats ethics and regulatory review. A network of phase 1 units with one shared review would open trials in many countries at once.
Copy the model that transformed HIV, TB and malaria care: a pooled international fund that pays for radiotherapy machines, pathology labs and essential cancer medicines where there are none.
Build the shared software, legal templates and data standards that let any hospital in the world join a cancer trial in weeks instead of years, the way the internet let any computer join the network.
Governments promised in advance to buy vaccines that did not yet exist, and they got made. The same promise could be made for a drug against a target everyone has given up on.
Guidelines usually wait for a drug to be licensed for a use before recommending it. For old drugs no one will license, guidelines should act directly on trial evidence.
Companies could choose to sell a new cancer drug at cost worldwide and instead be paid from a pooled fund according to how much health it actually delivers.
Cancer information tools must meet a tested standard: reading age around 12, main languages of the population, audio versions and clear numbers, or they are not certified for use.
Failed laboratory experiments are rarely published, so other teams repeat them. A searchable place to deposit them would save years of duplicated work.
Small European countries have started negotiating cancer drug prices together. A bloc of large middle-income countries would have far more bargaining power.
If a company refuses to supply its approved drug for a well-designed independent trial combining it with a rival's drug, the law would let the trial buy it at manufacturing cost, with results shared back.
Make clear who is responsible when an AI tool contributes to a mistake: protect doctors who use approved tools as intended, and hold makers responsible for the tool's performance.
Trial registries say a study is 'recruiting' long after it stopped, and never say whether a slot is actually open this week. A live feed of open slots per arm and site would let clinicians refer with confidence.
Hospitals in poorer countries often run out of basic, cheap chemotherapy for weeks. A shared live map of stock levels would let buyers and donors act before a child's treatment is interrupted.
Drugs fail for very different reasons: the target was wrong, the drug did not reach it, the side-effects were too bad, or the trial was badly designed. Recording which reason each time would show where the system is broken.
People are told a blood test can find fifty cancers, but not how many false alarms or how much is unknown. A short, tested decision aid before the test would make consent real.
Every time a team of specialists meets to plan a patient's treatment, they would have to record whether a trial exists for that patient and, if so, why it was or was not offered.
Running an early trial properly requires monitors, data managers, safety reporting and regulatory filings that universities cannot afford from commercial providers. A public not-for-profit would do this work at cost.
Create an independent public body whose job is to test cancer AI tools against each other on locked-away data and publish the scores, so hospitals can buy on evidence.
Patients wait weeks for a manufacturing slot while other slots go unused when a patient drops out. A shared booking system would match spare slots to waiting patients.
Someone must legally own a drug's licence to update its label and monitor safety. A non-profit could do this for old drugs proven to work in cancer that no company wants.
Build a drug company that does not need profits, modelled on the ones that developed new tuberculosis and sleeping-sickness drugs, to take on rare, paediatric and undruggable cancers.
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.
Companies fear that testing a combination will hand a competitor a patent. A shared pool where combination patents are cross-licensed by default would remove the fear.
For each treatment recommendation in the guidelines, publish a short explanation patients can read in their own language: what it is, why it is recommended, and what the evidence says.
Companies, hospitals and funders pool effort to train one very large AI on scans, slides, genomes and outcomes from millions of patients, kept at their hospitals, and share the resulting model.
No single company will spend a decade on a target that might be impossible. A shared, openly published effort across the twenty hardest targets spreads that risk.
A free web service where any app or hospital system can ask 'what is the recommended treatment for this exact situation today' and get a cited, versioned answer.
A simple website that shows, every year, how much research money each cancer receives compared with how many people it kills, so the gaps are impossible to ignore.
Rank hospitals and companies each year on how well their trial participants match the people with the disease in their area, and use the ranking when deciding who gets public research money and trial contracts.
Universities often refuse to be the legal sponsor of a first-in-human trial because they cannot afford the insurance and liability. A shared public insurance pool would remove that block.
Nobody keeps track of how differently the same drug is approved and dosed around the world. A public scoreboard would make the differences visible and push regulators to converge.
Combine cancer incidence with the location of open trials to show which regions have many patients but no trial within an hour's drive. Sponsors and funders would use it to decide where to put sites.
Keep a running, well-documented list of cancer practices and approvals that were reversed by later evidence, so the pattern of mistakes is visible and teachable.
Like a trial registry, every AI tool used on real patients would be listed publicly with what it is for, what data it was trained on, how well it performed and which version is running where.
Thousands of promising cancer compounds sit unused in university freezers and company archives. A public catalogue of what exists, what is known and who to ask would let others pick them up.
A searchable public record of clinics selling unproven cancer treatments, with the claims they make, the prices, the evidence and the harms reported by patients and doctors.
Measure and publish, for every practice-changing result, how long it takes before most eligible patients in each country and hospital actually receive it.
Test head to head whether an AI that reads the record and the evidence recommends treatments as well as a panel of experts, and whether patients do as well.
Trials tell us a drug works but not where it fits among the others. Commit to answering 'which order' from hospital data within a year of each approval.
Most lab experiments that fail are never written up, so other labs repeat them. A simple, structured registry with a citable record for each failed experiment would stop the waste.
Most of the delay in testing two companies' drugs together is lawyers negotiating from scratch. A single standard agreement, blessed by regulators, would let them sign in weeks.
Today a cancer drug is approved for shrinking tumours. A drug that stopped cancer spreading would fail that test, so almost nobody develops one. A new endpoint would fix that.
New ways of giving radiotherapy are adopted without the staged testing that drugs go through, and are then hard to evaluate. A defined pathway with fee waivers and clear evidence steps would bring rigour without blocking progress.
Targeted cancer drugs often reach a country years before the test needed to select patients is approved there. Recognising other regulators' test approvals would close the gap.
Create a way for a charity or university to get a cheap old drug officially approved for a new cancer use, with a few years of protection on that use so trial costs can be recovered without high prices.
Metastasis causes about nine in ten cancer deaths but gets a small slice of research money. This would ring-fence a tenth of national cancer research budgets for the biology and trials of spread itself.
Companies hold thousands of well-characterised drugs that could help rare cancers, but each request takes a year of legal negotiation. One standing agreement would unblock it.
People are invited separately for bowel, breast, cervical and lung screening and many miss some. One appointment offering all eligible tests, plus a risk assessment, would raise uptake.
If a cheap old drug could replace or reduce an expensive cancer treatment, health systems save money. Investors could fund the trial and be repaid from those savings if it works.
Some drugs are approved for any cancer with a particular mutation. Clear rules on how many cancer types must be tested, and how to combine results across them, would make these approvals more consistent and faster.
Instead of a new trial for each resistance mechanism, one continuous trial could sort patients into arms based on the reason their last treatment failed.
Sometimes a treatment must be designed for a single patient. Agreeing in advance what evidence and safety checks are needed would make that fast, fair and learnable.
Surgery and radiotherapy cure more people than drugs but get a fraction of trial funding because there is no company sponsor. A rule would guarantee them a fixed share of public trial money.
Two people can have identical treatment and only one develops heart failure or a second cancer years later. Collecting blood and genetic data from survivors could reveal who is at risk and who can be reassured.
Tens of millions of people live after cancer with heart damage, infertility and second cancers. A tiny levy on the price of curative treatments would build a permanent fund to study and treat late effects.
Most cancer deaths are in low and middle income countries, where scans and endoscopies are scarce. A cheap methylation blood test tuned to liver, stomach, oesophageal, cervical and breast cancer could fill the gap.
Scans find unexpected lumps in the adrenal, thyroid, pancreas and lung. Nobody knows how many matter. A national cohort following them for ten years would tell us whom to watch.
New surgical tools, imaging probes and radiotherapy hardware invented in universities rarely attract investors. A dedicated fund would pay for prototyping, safety testing and first-in-human studies.
Most people with cancer are over 65, but most trial patients are younger and fitter. A dedicated fund would pay for trials designed for the patients we actually treat.
Getting a cell line, mouse model or antibody from another lab can take six months of paperwork. Funders would require a standard agreement that goes through automatically unless someone objects within thirty days.
Wherever cancer information appears online, a visible marker shows whether it matches what trusted sources say, with a one-click link to the plain-language evidence.
Train a model on millions of experiments where genes and drugs were altered, so it can predict the effect of a new combination without running the experiment.
Instead of separate screening programmes for a few cancers, assess every adult's overall cancer risk and offer blood tests, imaging and preventive treatment tuned to that risk, all inside one system that learns.
When a resistance mutation first appears in the blood, the current drug is often still controlling most of the tumour. Adding a second drug rather than swapping may keep both under control.
Some drugs work on a genetic change whatever the cancer. When one regulator approves such a label, others should adopt it rather than demanding trials per cancer type.
Payers would promise in advance to buy a set number of doses at a set price for any drug that meets a defined bar in a rare or childhood cancer, so companies know the market exists before they invest.
For treatments of symptoms like nausea, fatigue or neuropathy, each patient can try the drug and a placebo in alternating periods and see what works for them; pooling many such personal trials gives a population answer too.
Statistical methods can combine information across similar rare cancers to reach an answer with fewer patients. Regulators need to say in advance when that is acceptable.
Many cancer proteins have shapeless, flexible regions that drugs cannot hold on to. New protein design software may be able to invent binders that clamp them.
Once a class of antibody such as PD-1 blockers is proven, later copies could be approved on smaller trials showing equivalence, forcing price competition and freeing patients and money for genuinely new drugs.
Immunotherapy patents start expiring around 2028. Guaranteeing in advance to buy cheap copies for poorer countries would make sure manufacturers build the capacity.
Mine grant databases and the literature to find cancer types and questions with heavy burden and zero active projects, then publish the list so funders and scientists can go there.
Companies say competition law stops them coordinating on combination trials and sharing failure data. A clear legal safe harbour for defined pro-patient collaborations would remove that excuse.
A supportive-care ARPA would be a well-funded, milestone-driven agency that develops drugs for nausea, nerve damage, mouth sores, fatigue and brain fog from cancer treatment, which the market has largely ignored.
Every patient newly diagnosed with advanced cancer would have their records reviewed by an expert centre within a week, without travelling. The review often changes the plan.
Hospitals buy multi-million-dollar surgical robots and AI tools with little proof they help patients. An independent body would run the comparative trials, and payers would only pay premiums for what is shown to work.
Some things called cancer, such as low-grade prostate lesions, almost never spread. An expert body could reclassify them, as cervical precancer was, so fewer people are overtreated.
Countries negotiate secret discounts, so nobody knows what anyone actually pays for a cancer drug. Sharing real prices between public buyers would strengthen every negotiation.
Companies would put their cancer drugs into a shared licensing pool so that any qualified investigator can test combinations of drugs from different owners under one standard agreement, with royalties split by a fixed formula.
Pool the side-effect and quality-of-life data patients report in trials into one open database so regimens can be compared honestly and models can be built.
Academic labs find new tumour targets but cannot turn an antibody into an antibody-drug conjugate or a bispecific without licensed linker and payload technology. A shared platform would provide that at no cost for first trials.
Ask experts and models to predict, in public, which registered combination trials will meet their endpoint. Track who is right, and use the best forecasters to decide what to fund.
No one knows exactly how many oncologists, nurses, physicists and pathologists each country has or needs. A public, regularly updated model would let governments plan training and spot shortfalls years ahead.
Each cell-therapy machine uses its own proprietary process and cartridges. A common standard would let a process run on any machine, like a document opening in any word processor.
Design a radiotherapy machine from scratch for hospitals with patchy electricity, heat and few engineers, and publish the design so several companies can build it cheaply.
Different cancers favour different organs, and so do different patients. A model that predicts which organ is at risk could target surveillance and prevention.
Almost every newly diagnosed patient searches for what to eat and finds sugar-starvation, alkaline and juice-cure claims. If the oncology team asks about diet first and hands over good information, the myths have less room.
Most cancer patients are treated outside big academic hospitals, but most trials are run inside them. Requiring a share of sites to be community practices would bring trials to where patients are.
Hospitals hold weekly meetings to decide each patient's plan but rarely check what happened afterwards. A simple loop that records the recommendation and checks it against what was done would catch dropped plans.
When a study is retracted or corrected, every guideline and software tool that relied on it would be alerted automatically, so wrong evidence stops influencing care.
When a company stops developing a cancer drug for business reasons, the rights and data would automatically be offered to charities and universities on set terms after two years, so promising compounds do not disappear.
A rare cancer drug designated 'orphan' in the US must reapply in Europe, Japan and elsewhere. Recognising each other's decisions would save small companies months.
Fear of losing insurance stops many people having genetic tests. Extending non-discrimination law to life and disability cover, as Canada has, would remove that fear.
To prove a leftover-cancer test works you need blood taken years before relapse. Collecting and freezing yearly samples now makes every future test testable.
Results can change when a supplier changes a batch of serum, antibody or growth factor. Recording which batch was used in each experiment, in a shared ledger, would let these effects be spotted.
Trials look at dozens of patient subgroups and some will look good by chance. A statistical method that pulls extreme subgroup results toward the overall result would make these claims more honest.
Pay a reward to any lab that carefully tries to repeat an important cancer finding and documents that it did not work. Today that work is unpaid and unpublished.
Some cancer-driving proteins gather into droplet-like blobs inside the nucleus to switch genes on. Drugs that dissolve those blobs might switch the cancer programme off.
Cancer usually kills by spreading to bone, liver, lung or brain. Almost all laboratory models grow tumours under the skin instead, where the surroundings are nothing like those organs.
Seven in ten cancer deaths are in poorer countries, yet almost all trials happen in rich ones. Funders would commit a share of money for trials designed and led where the burden is.
Funders would publish how their spending compares with deaths and years of life lost per cancer, and commit to shift a fixed share of money each year towards the biggest gaps.
Gut bacteria appear to influence whether immunotherapy works, and diet and antibiotics shape gut bacteria. Yet almost no drug trial records what patients ate or which antibiotics they took. Recording it would cost almost nothing.
Slow weight loss and falling daily activity are the first signs of cancer wasting, and both can be measured at home. An alert could bring help months earlier.
HPV throat cancer now exceeds cervical cancer in some countries and mostly affects men, who were not vaccinated. Vaccinating men up to 45 could reduce it.
Regulators would test and certify that every hospital cancer system can export its records in a standard format, the way electrical appliances are certified safe.
When a hospital's real limit is the number of chemotherapy chairs and nurses, guidelines should favour treatments given by mouth or in fewer, shorter visits, if they work about as well.
Improving how a cell therapy is made currently risks having to repeat clinical trials. A validated computer model plus a fixed set of product measurements would let changes be approved on data alone.
Three companies testing three drugs against the same standard treatment each recruit their own control group. Pooling those controls in one shared study would need fewer patients and answer faster.
Scientists are promoted for novel discoveries, not for checking others' work or sharing data. Changing what universities reward would change what scientists do.
Use tumour DNA in the blood as the signal to pause and restart a lung cancer pill, keeping the tumour in check while slowing the rise of resistant cells.
Governments and philanthropists commit large payments for whoever achieves a verified jump in ten-year cure rates for a specific cancer, however they do it.
Some cancers escape treatment by changing into a different kind of cell that the drug no longer affects. Tumour RNA in blood could show this shift months before a biopsy would.
Children wait years for drugs because adult trials come first, even when the target belongs to a childhood cancer. Some drugs should start with children.
Taxpayers fund much of the science behind new cancer drugs but never learn what they cost to develop. Disclosure should be a condition of public payment.
Chemotherapy doses are calculated from height and weight, a formula from the 1950s. Doses based on actual muscle mass may cause fewer severe side-effects.
A drug label says 'for PD-L1 positive patients' but does not say that other tests give different answers. Labels should list the validated tests and how much they disagree.
Most of the money in cancer goes to treatments that help a few people for a short time, while pain relief for the dying, which is cheap and works, gets almost nothing. Ring-fencing a small fixed share would change that.
Trial results are often presented at conferences months or years before the full paper appears, leaving doctors to act on slides. Require that the full structured results are published the same day.
For people at very high cancer risk, install a small population of engineered immune cells that live for years and destroy cells showing early cancer signals before a tumour forms.
Companies often delay the childhood cancer studies they are required to do. A slice of the adult drug's revenue would be held back until the paediatric trial is completed.
Air pollution causes lung cancer in people who never smoked. Clean air zones and coal phase-outs should be tracked against never-smoker lung cancer rates.
Trial visits happen on weekdays during working hours, which excludes many people with jobs or caring duties. Running research clinics in the evening and at weekends is a simple test of whether that matters.
Require that approved cancer drugs come with a standard set of data (blood levels, drug interactions, toxicity profile) so anyone can design a safe combination trial without asking the company.
Make the first project of every doctoral student a careful, published attempt to repeat an important result. Students learn rigour, and the field gets thousands of replications a year.
Labs testing new cancer compounds should always include a few well-known drugs as controls and report how those behaved, so results from different labs can be compared.
Drugs approved early on promising but unproven results would have every treated patient followed in a registry, so we know within two years whether the promise held.
When doctors discover how a tumour escaped a drug, that finding usually stops at a paper. Recreating it in a model gives everyone a system to test the next drug against.
Screening finds cancers that would never have caused harm, but programmes only report cancers found. Publishing the estimated overdiagnosis rate alongside would make the trade-off visible.
Cancer is an evolving population, but treatment decisions are rarely made with an evolutionary biologist present. Add one to the weekly meeting and see whether decisions change.
Use AI translation plus expert checking so that when a cancer guideline changes, doctors in every major language see the change within a month rather than years.
No cancer AI would be approved until it has been tested on patients from at least five different hospitals in at least two countries, none of which contributed training data.
Companies lose money when they prove a shorter course works, so they never test it. Give them a modest reward, such as extra months of exclusivity, when they do.
When two cancer drugs are combined, each is usually given at its full single-agent dose, which often proves too toxic. Testing a grid of dose pairs would find combinations that work with tolerable side effects.
Trained cancer doctors and nurses who have fled conflict or moved countries often spend years unable to practise. A short, competency-based route back to work would add capacity quickly.
Cells that receive only a small amount of a drug survive and adapt. Measuring where inside a tumour the drug actually reaches would show where resistance is being bred.
Flu vaccines are chosen by predicting which virus strains will dominate next season. The same forecasting maths could predict which resistance mutation a patient's tumour will develop next.
Fast grants for oncology would be a fund that decides within two days on small grants for quick, decisive experiments in cancers or questions that mainstream funders neglect, modelled on the pandemic-era Fast Grants.
Wikipedia is where most people first read about their cancer. Pay clinicians and librarians to keep the cancer pages accurate, current and readable in many languages.
Almost no surgeons or radiation oncologists have time or funding to do research. Dedicated training awards with protected time would build the workforce that surgical and radiotherapy trials need.
Pay scientists a small bonus, added to their grant, when they post their results and data openly within six months of finishing an experiment, whether the result was positive or not.
Coaching-based weight loss did not clearly cut breast cancer recurrence in BWEL, perhaps because the weight loss was too small. Drugs that produce three times as much weight loss could settle whether weight itself matters.
Millions now wear continuous glucose monitors. A sudden, unexplained worsening of glucose control in a middle-aged wearer could be flagged as a possible early sign of pancreatic cancer.
Investors avoid genuinely new cancer drugs because most fail in mid-stage trials. A public insurance scheme would repay part of the loss when a first-in-class drug fails honestly, making the bet worth taking.
Companies get longer monopolies for rare and paediatric cancer drugs. That reward should come with a commitment to sell at cost in low-income countries.
Treatment guidelines tell doctors what to do at each step but rarely which trials are open for that step. Adding a live, monthly-updated list to each decision node would put trials where doctors look.
Doctors who could turn discoveries into trials are buried in clinical work. Hospitals would guarantee them research time and recover the cost from the trials and grants they bring in.
Simulating thousands of virtual patients on a computer can suggest which dose and schedule to test, so fewer real patients receive doses that are too high or too low.
Simulate trials of drug combinations in populations of virtual patients to decide which real trials to run, and keep score of how often the simulations were right.
If a lipid nanoparticle can make CAR-T cells inside the body for lymphoma, it could be redosed weekly against solid-tumour targets that autologous CAR-T cannot sustain.
Half of hormone-positive recurrences happen after year five. Blood tests during long-term follow-up could find them early and an oral SERD might stop them.
Desmoid tumours are not cancers and often stop growing on their own; treating them indefinitely with a drug that causes ovarian failure may be more than needed.
The people who run funding programmes are judged on money moved and papers produced. Judge them instead on whether their portfolios match the burden of disease and whether the trials they fund finish.
Melanoma diagnoses have soared while deaths barely changed, a sign of overdiagnosis. AI skin apps should be judged on whether dangerous thick melanomas fall, not how many spots they flag.
After surgery, a tumour with its blood vessels can be connected to a pump and kept alive for hours or days, allowing drugs to be tested in genuinely human tissue.
Dosing advice for people with weak kidneys or liver is often missing at approval and added years later, if ever. Requiring those studies before approval would protect a large group of real-world patients from day one.
Drugs are described as phase 1, 2 or 3 so everyone knows how proven they are. Biomarkers should carry the same kind of label so a 'promising' marker is not mistaken for a validated one.
Pay more for drugs that clearly help people live longer or better, and less for those that barely move the needle, using a public benefit scale doctors already use.
Blood tests that look for many cancers at once take a decade to prove they save lives. Regulators could accept fewer late-stage cancers as the first answer, if trials keep counting deaths afterwards.
A drug approved in the US may take five years to reach a patient in Poland or never reach Nigeria. A live public tracker would show exactly where and why it is stuck.
You cannot fix what you cannot count. Every donor-funded cancer programme should fund and require a population-based cancer registry so results can be measured over time.
Dentists see the mouth more than any doctor. A standard, recorded oral cancer examination with a referral route would catch cancers earlier at almost no cost.
A drug that shrinks a tumour by half but leaves the resistant sub-population untouched will fail. Trials should measure whether every sub-population is cleared, not just overall size.
Children's cancers are treated with combinations, but companies study new drugs in children one at a time. Approvals should require the combination study children actually need.
When a screening test misses a cancer, we should know. Linking every negative result to the cancer registry and publishing what was missed, by stage, should be a condition of use.
Every funder that spends more than $50 million a year on cancer research would publish what it funds in a shared, coded database, so gaps and duplication can be seen across the whole system.
Once an AI tool is in use, its maker and the hospital would have to report regularly how it is actually performing on real patients, and the reports would be public.
Patients and doctors cannot see how long each CAR-T maker takes or how often manufacturing fails. Publishing this would create pressure to get faster and more reliable.
Radon gas from the ground is the second biggest cause of lung cancer. Testing every home at sale and paying for fixes in high-radon areas would prevent thousands of cases.
Older, frailer and sicker patients are usually kept out of trials but make up most of those treated. Require companies to report how these patients do in practice.
Every AI tool would have to report how well it works for women and men, different ethnic groups, ages, scanner types and hospitals, not just an overall score.
Trials and hospital records describe the same things in different languages. Publish the translation so trial patients can be followed for life in routine data and trial results compared with routine care.
Blood tests tell you which tumour sub-populations are growing; scans tell you which lesions are growing. Joining the two would tell you where to biopsy or irradiate.
The support cells that build a tumour's scaffolding come in several types: some protect the tumour, others restrain it. Treating all of them the same way explains past failures.
Hospitals publish survival and infection rates but almost never how many of their cancer patients are in uncontrolled pain. Measuring and publishing it would make pain a priority.
Metastasis causes most cancer deaths, yet no drug is developed to stop cells spreading. Create a formal approval route for drugs that prevent metastasis, tested in people at high risk of it.
When a trial changes the standard of care, every oncologist would receive a five-minute, case-based lesson within a month, rather than waiting for the next conference.
Pay a fixed prize, of tens of millions, to the first team to show that a completely new way of attacking cancer works in patients, so that the riskiest early bets are rewarded even before a product exists.
A van equipped for blood draws, ECGs, questionnaires and drug hand-over could visit rural towns on a schedule so trial participants there do not have to travel hours each cycle.
Old autopsy studies found hidden prostate, thyroid and breast cancers in many people who died of other causes. Repeating them with modern methods would show how large the reservoir of harmless cancer is.
In places where sophisticated machines break down, a modern version of the older cobalt radiotherapy unit, upgraded with image guidance, could treat more people reliably while infrastructure catches up.
If one lab suddenly starts finding twice as many 'positive' results as others, something has gone wrong with its test. Pooling positivity rates across labs would catch this automatically.
A trial approved by a qualified ethics committee in one country would not need to repeat the full review in another; the second country would accept the first review and check only local issues.
Hospitals would only be paid for cancer treatment if they record a small, standard set of facts (diagnosis, stage, biomarkers, treatment, outcome) in a shared format that any computer can read.
Starting a cancer trial in ten countries means ten applications and ten ethics reviews. One shared application and a common ethics template would start trials months sooner.
When a drug is approved early, each country often demands its own follow-up study. A single shared registry would answer the safety questions faster and better.
Prevention trials are slow and run separately. A shared platform trial across precancers like Barrett's, oral leukoplakia, lung nodules and pancreatic cysts would test many drugs faster.
Companies and charities give or discount cancer drugs in poorer countries, but nobody records whether the patients did well. Make a simple outcome record part of every programme.
Companies currently reformat the same evidence for every country; a single machine-readable dossier that every regulator reads from would save years of work.
Guidelines paid for with public or charitable money would be published under an open licence so any hospital system, app or country can build them in without permission or fees.
Preparing a regulatory filing requires expensive specialist software and consultants. Free, open tools would let universities and small generic firms file in more countries.
For cancers too rare or too poor to attract companies, run drug discovery in the open, the way neglected tropical diseases are tackled, and take candidates to first human trials with public money.
Whether finding cancer earlier saves lives depends on the cancer. Public models, one per cancer, would let trials and payers predict the mortality benefit from a stage shift honestly.
Every trial writes its protocol and analysis plan from scratch. A shared library of well-written templates and ready-to-run analysis code would let teams start from the best version rather than a blank page.
Clinical trials get expert statistical review; the laboratory studies that justify them usually do not. Paying statisticians to review these papers before they influence a trial would catch errors early.
Once a proposal in a neglected cancer passes a quality bar, pick winners by lottery instead of by tiny differences in review scores, which mostly reflect fashion.
A drug that adds years of life would earn extra years of market protection; one that adds a few weeks would earn none. Extensions would be lost if the promised benefit is not confirmed.
Every patient would be able to see which AI tools were used in their diagnosis or treatment plan, what they do, how well they work and how to question them.
Health systems would pay for AI tools that have shown in trials that they help patients, and pay nothing for tools that have not, giving makers a reason to run the trials.
Leftover-cancer blood tests are being sold faster than evidence that acting on them helps. Paying for them only when the result is recorded would generate the missing evidence.
Health systems earn from treating cancer, not preventing it. Paying them for lower cancer incidence and earlier stage in their population would flip the incentive.
Trial sites are paid per patient recruited, so nobody is paid to finish the study or report the answer. Shift part of the payment to completion and publication within a year.
Discussing and enrolling a patient in a trial takes an oncologist far longer than prescribing the usual treatment, and they are not paid for it. Paying for that time would remove a quiet disincentive.
Trial visits take hours and cost people wages. Paying a fair hourly rate for time spent beyond normal care would make trials possible for those who cannot afford unpaid days off.
Insurers already pay for many untested drug combinations. Paying only when the patient joins a simple randomised comparison would turn that spending into evidence.
Even when a trial proves a cheap old drug helps, insurers may refuse to pay because it is not licensed for cancer. A standing promise to pay would remove that fear.
If two drugs extend life equally but one makes patients much sicker, the health system should pay less for the sicker one. Build that into how prices are set.
Labs usually use whichever tumour models they already have. A searchable index that finds the model closest to a specific patient's tumour would make experiments more relevant.
Dozens of trials have collected immune, genomic and imaging data on the same drugs. Nobody can analyse them together, so the answer stays hidden in fragments.
Once a drug is in wide use, real-world records could be checked routinely for whether side effects differ by ancestry or sex, since trials were too small in those groups to notice. Findings would go into the label.
A trial can be designed to detect a tiny improvement that is statistically real but too small to matter. Protocols should state up front what size of benefit would be worth having, and be built to detect that.
A cancer blood test improves every year, but a ten-year trial tests the old version. Regulators and sponsors could agree in advance how updates are validated and carried into the result.
Clinical trials must be registered before they start so that failures cannot be hidden. Animal studies used to justify human trials should follow the same rule.
Drug trials must be registered before they start so results cannot be hidden or reshaped. Studies that claim a biomarker predicts outcome should be registered too.
Just as clinical trials must be registered before they start, studies using hospital data should be registered too, so the failed or unwelcome ones cannot quietly disappear.
Some cancers reach the brain in up to a quarter of patients. Prevention trials could aim specifically at stopping that, instead of treating it once it has happened.
A drug's label should say plainly how well the people in its trials matched the people who get the disease: 'Black patients were 4 percent of participants and 22 percent of cases.' Doctors and patients can then judge how far to trust the result.
Nobody can patent a better way of operating or a shorter radiotherapy schedule, so nobody is rewarded for proving one. Prizes for technique improvements shown to work in trials would fill that gap.
Universities and cancer centres would change how they promote scientists, giving credit for finishing trials, sharing data, replicating others' work and publishing failures, not just for papers in famous journals.
A public investment fund would match private money in the riskiest early trials of truly new cancer drugs, taking a small share of future royalties so that taxpayers gain when the bets pay off.
When an aeroplane crashes, an independent report explains why so it does not happen again. When a cancer drug programme is abandoned, nothing is written. Change that.
Hospitals buying cancer software with public money would be required to include contract terms guaranteeing free, standard data export and no penalties for switching.
If public or charity money paid to build a cancer AI model, the model itself (not just a paper about it) must be released so others can test, improve and use it.
Nobody knows what a cancer trial should cost because budgets are secret. Publishing anonymised cost per patient by trial type would expose waste and let funders set targets.
Trials record why each screened patient did not join, but that data is never shared. Publishing it would show which rules block the most people and which are pointless.
The Lancet Commission defined a cheap basic package of drugs, equipment and staff for palliative care. Countries expanding health coverage should include it as a guaranteed benefit.
Regulators are unsure what to accept as proof that an anti-wasting drug helps. Agreeing on a simple measure such as stair climbing would unblock the whole field.
Funders should randomly select a small fraction of the papers they paid for and check the raw data, analysis and records, with public results. The possibility of an audit changes behaviour.
Trials usually study one treatment at a time, so nobody knows the best order. Deciding the next step in advance, by lottery, answers the sequencing question at little extra cost.
Antibody drugs need their target to still be present. After one fails, checking which surface markers remain would guide the choice of the next one instead of guessing.
How long people wait between first noticing something wrong and being diagnosed is barely measured. Recording it routinely and publishing it by hospital would expose where the system loses time.
How a tissue sample is handled before it reaches the lab changes the results of biomarker tests. That handling time is almost never recorded, so nobody can tell a true negative from a spoiled sample.
Different companies' leftover-cancer blood tests disagree, and there is no shared yardstick. Public reference samples would let anyone check which test actually works.
Randomise people through the national health system, post the blood kit, and read cancer deaths off the registry. That is ten times cheaper per participant than a classic trial.
Few companies develop cancer prevention drugs because trials take decades. If regulators accepted validated precancer endpoints, as they do cholesterol for heart disease, industry would return.
A test approved to select patients for a drug in the US must go through separate approval in Europe, Japan and elsewhere, delaying the drug. Accepting each other's test approvals would fix the delay.
People with serious mental illness or dementia are routinely excluded from cancer trials, though they get cancer just as often and do worse. Supported consent and reasonable accommodations would let many take part.
Most trials use the same blood-test cut-offs for kidney and liver function regardless of how the drug is cleared from the body. Setting the cut-off from the drug's own pharmacology would let many more people join safely.
A treatment that adds two months of life but takes up most of those days in hospitals and clinics may not be worth it to an older patient. Trials should report how many days treatment consumes.
Whether a drug gets into the brain is measured early in development but rarely published. Making that number public would show which existing drugs could treat brain disease.
Once two drugs of a kind exist, a third should have to prove itself against the best of them, not against an outdated comparison, so patients and payers learn which is actually better.
New cancer drugs are approved on trials of younger, fitter patients, then given mostly to older ones. Regulators should require real-world safety and benefit data in the over-75s and put it on the label.
Many cancer specialists trained in poor countries emigrate. Combine service bonds, salary supplements, guaranteed working equipment and academic time so that staying is a career, not a sacrifice.
Hospitals rotate antibiotics to stop bacteria adapting. Cycling between two cancer drugs on a set schedule, rather than using one until it fails, might work the same way.
Just as drugs are withdrawn when they prove unsafe, AI tools should have clear triggers for being switched off, and someone responsible for pulling the switch.
Scientists hide results for fear of being beaten to publication. If journals and funders guaranteed that a preprinted finding cannot be scooped, and encouraged rival groups to publish side by side, sharing would become safe.
For each type of laboratory model, keep a public record of how often its predictions came true in patients, so that researchers know which models to trust for which question.
Wasting has several causes. Measuring the specific hormone in each patient's blood would put the right patients into the right trial instead of mixing everyone together.
Before spending millions to turn a lab finding into a drug, spend a little to have an independent lab check it is real. Funders would reserve a small slice of money for exactly this.
Mutations in the cell's editing machinery make recurrent abnormal proteins across many patients. If those are visible to T cells, one vaccine could serve many people instead of being built per patient.
The fifth PD-1 antibody that is no better than the first should not get the same market protection as the first. Exclusivity would shrink for copies that add nothing.
Hospitals rarely know which step, the scanner, the biopsy, the pathologist or the clinic slot, is causing the queue. Modelling the pathway like a factory line shows where a small change would remove weeks of waiting.
If the protein cannot be drugged, target the message that makes it. Small molecules can now recognise folded shapes in RNA and recruit an enzyme that chops it up.
Real treatment is a series of decisions: start with this, switch to that if it fails. Sequential multiple-assignment randomised trials test whole strategies by randomising patients again at each decision point.
Losing weight without trying is one of the strongest signs of hidden cancer, but it is rarely measured. Automatic alerts from recorded weights could prompt a check-up.
Investors would fund vaccination and screening campaigns up front and be repaid by health systems only if the campaigns hit verified targets, turning future savings into money for prevention now.
Hospitals often lack the staff to switch patients to cheaper equivalent drugs. Private investors could fund the switching teams and be repaid by the health system from the money saved.
People who grew up in East Asia, Eastern Europe or Latin America keep a high stomach cancer risk after migrating. Cheap blood tests could select who needs an endoscopy.
One in five people with advanced cancer has brain spread, yet most trials refuse them. Requiring brain cohorts would give those patients evidence instead of guesswork.
Many big trials continue for years after the data already show the drug is unlikely to work. Agreeing in advance to stop earlier when the odds look bad would spare patients and free money for better ideas.
Trials often impose heavy contraception rules and exclude anyone pregnant or breastfeeding, even when the drug is unlikely to be harmful. Sensible, evidence-based rules and pregnancy registries would include more young women and produce data they currently lack.
Small pancreatic cysts are found on many scans and followed for life. Evidence suggests those unchanged for five years rarely turn to cancer. A stopping rule would spare years of scans.
Newborn sequencing programmes exclude adult cancer genes because babies cannot consent. Storing those results and offering them at 18 would preserve choice and give a lifetime of prevention.
Doctors and patients could subscribe to a specific cancer, stage and biomarker and be told, with sources, the moment the recommended treatment changes for that situation.
Species go extinct when a second disaster hits a population already shrunk by a first one. Apply the same logic: hit the tumour with a different kind of drug when it is smallest, rather than waiting for it to grow back.
Instead of blocking a cancer protein, add a chemical off-switch to its gene so the cell stops making it. Early versions of this tool are being tested in other diseases.
Give a small number of scientists a decade of guaranteed funding to work on a single hard problem such as dormant cancer cells, with no pressure to publish quickly.
Muscle is an immune organ as well as a movement organ. Building it during immunotherapy might improve how well the treatment works, not just how patients feel.
The pathologist is the first person to know a cancer is rare or has a targetable marker. A rule in the lab system could notify a trial team at that moment, before treatment decisions close the window.
Nobody funds trials of old drugs because competitors can sell the result for free. A short exclusive period for the new use, like the one given for children's studies, would change that.
When a cancer drug is added to the WHO essential medicines list, the maker should publicly commit to a low price and reliable supply for poorer countries, or the listing is withheld.
For treatments that will not cure, what matters is how long the treatment keeps working without becoming unbearable, and how the person feels. Trials should measure both of those as their main results.
Electronic notebooks record when each experiment was done and what the raw result was. Submitting them with the paper would show whether the analysis was planned or fitted after the fact.
Tumour DNA in blood can be told apart by chemical marks as well as mutations. Marks are more numerous and cheaper to read, so they could track more sub-populations for less money.
Reward companies that deliver a genuinely new kind of cancer drug with a sellable voucher for faster review of another product, but only if they agree to fair pricing and global access.
A fifth of patients with solid tumours develop brain metastases and are usually excluded from trials. This would fund a programme that studies and treats them as a disease in their own right.
Countries track how bacteria become resistant to antibiotics and publish it. Doing the same for cancer drugs would show which escape routes are becoming common and where.
Hospitals have fast, standard responses to sepsis and heart attacks. Cancer wasting has no such pathway, so it is noticed late and treated inconsistently.
For rare cancers, the patient is often at a hospital that has no trial. A ready-made kit with the protocol, consent forms, database and shipping already set up would let that hospital enrol them within days.
When morphine is unavailable, patients get nothing. Some cheap alternatives, such as methadone or tramadol, may work for cancer pain but have not been properly tested in these settings.
Postdocs who discover something promising usually have to leave it behind when their contract ends. A fellowship would pay them for two years to turn it into a candidate drug or diagnostic, with mentors from industry.
When universities license cancer discoveries to companies, the contract would reward companies that price fairly and sell in poor countries, and penalise those that do not, using the royalty rate as the lever.
Cell therapies are tested for purity and count, but not for whether they can actually kill that patient's tumour. Testing them against the patient's own mini-tumour would show this.
A platelet count that is normal but rising year on year, or haemoglobin drifting down, can signal cancer. Records already hold these trends; software could use them.
Resistance often arrives as the same few mutations. Teaching the immune system to recognise them in advance could remove the escaping cells while they are still rare.
Build a computer model of each patient's cancer and body that simulates how different treatments would go, and prove in a proper trial that choosing treatment with the model helps.
Every patient on the new drug is compared with every patient on the old one: who lived longer, and if equal, who had fewer serious side effects, and if still equal, who felt better. The share of 'wins' becomes the result.