OnCo
ideasIdea

An ARPA-style programme to develop supportive-care drugs nobody else will

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.

Supportive-care drug development has stalled: the last major antiemetic class (NK1 antagonists) is over twenty years old, there is no approved preventive for chemotherapy-induced neuropathy, and fatigue and cognitive impairment have no pharmacological standard. The proposal is a dedicated programme (public or philanthropic, ARPA-H style) funding target discovery, repurposing screens and pragmatic trials of supportive-care agents, with pull incentives (advance purchase, priority review vouchers) for approvals.

Hypothesis
A ten-year, well-funded programme delivers at least three new approved supportive-care agents and measurably reduces dose reductions and discontinuations for toxicity across common regimens.
Rationale
Supportive-care drugs are generics-priced and off-patent-adjacent, so private investment is weak although the population is enormous and the endpoints are fast. Focused public programmes have succeeded where markets failed (antibiotics, neglected diseases).
What would test it
Fund a first cohort of five programmes (neuropathy prevention, mucositis, cachexia, fatigue, cognition) with 3-year go/no-go milestones; success is two reaching phase 3 with positive phase 2 signals.
Maturity
speculative
Who has to act
philanthropy
Cost to try
Large (over $50M)
Years to first evidence
6
Bottlenecks it attacks

Connected

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