OnCo
ideasIdea

Regulators accept shrinking of precancer as the endpoint for prevention drug approval

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.

Precursor regression (CIN2+, colorectal adenoma, Barrett's dysplasia, oral leukoplakia) has established links to cancer risk. Propose a regulatory framework accepting defined precursor endpoints for conditional approval, with mandated long-term cancer incidence follow-up.

Hypothesis
A precursor-endpoint pathway triples the number of industry-sponsored chemoprevention trials within five years.
Rationale
Statin and antihypertensive development depended on surrogate endpoints; cancer prevention has none accepted.
What would test it
FDA and EMA guidance, then count trials registered before and after.
Maturity
speculative
Who has to act
regulator
Cost to try
Small (under $1M)
Years to first evidence
4
Bottlenecks it attacks

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