OnCo
ideasIdea

Stop over-excluding people who could become pregnant; study pregnancy exposure

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.

Contraception requirements are set from the drug's actual reproductive toxicology rather than a blanket 'two highly effective methods'; breastfeeding exclusion is replaced by lactation PK studies where feasible; and pregnancy exposure registries are funded for oncology drugs so that the inevitable exposures generate data. Adolescent and young adult women are disproportionately affected by current rules.

Hypothesis
Evidence-based reproductive criteria will increase enrolment of women under 45 without increasing exposed pregnancies, and lactation and pregnancy registries will generate label information for most oncology drugs within a decade.
Rationale
Cancer in pregnancy and in lactating women is treated on almost no data; young women decline trials because of contraception burden; other therapeutic areas have moved to risk-based reproductive criteria.
What would test it
Audit contraception criteria against reproductive toxicology for approved agents; pilot risk-based criteria in one cooperative group and measure enrolment of women under 45 and exposed pregnancies.
Maturity
speculative
Who has to act
regulator
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks

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