A neutral platform trial for radiotherapy plus immunotherapy combinations
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.
A master protocol operated by academic radiotherapy groups (through a neutral sponsor) in which multiple companies' immunotherapies are tested in combination with standardised radiotherapy schedules, doses and target volumes across defined indications (oligometastatic disease, locally advanced head and neck, lung, bladder), with a shared control arm and pre-specified translational sampling. Existing RT-IO trials use inconsistent radiotherapy, making negative and positive results hard to interpret. Radiotherapy groups have the trial infrastructure but no access to drugs; companies have drugs but do not prioritise radiotherapy combinations, so the pairing is a natural public-private platform.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Secrecy and intellectual property block collaboration · Companies with complementary drugs rarely test them together, and data that could answer questions stays locked up.
- Too many combinations to test · There are thousands of possible drug pairs and sequences. Trials can test a few dozen a year.