OnCo
ideasIdea

Rotate between drugs on a fixed schedule instead of waiting for failure

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.

Antibiotic cycling and mixing are used to manage resistance in intensive care, with mathematical models predicting when each is superior. In oncology, drugs are almost always given until failure. Where two agents with non-overlapping resistance mechanisms and tolerable toxicity exist, scheduled rotation before resistance is established could keep both populations suppressed. Modelling should precede the trial to choose cycle length.

Hypothesis
Scheduled rotation between two non-cross-resistant agents extends time to progression compared with sequential use of the same agents, with equivalent cumulative toxicity.
Rationale
Rotation denies any single clone a sustained selective advantage; the approach requires only existing drugs and a schedule change, making it unusually cheap to test.
What would test it
Model-informed randomised phase 2 in a setting with two well-tolerated non-cross-resistant options (for example endocrine agents or maintenance regimens), comparing rotation with sequence.
Maturity
speculative
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
5
Bottlenecks it attacks

Connected

5top