ideasIdea
A publicly held library of investigational drugs available for academic combination trials
A government or charity holds stocks of experimental cancer drugs under standing agreements, so academic doctors can test combinations without negotiating with each company separately.
NCI's CTEP investigational agent programme has run for decades but covers a narrow set of agents and mostly US sites. A broader, international formulary of investigational and newly approved agents held under pre-agreed terms (including pricing for trial use of approved drugs) would let cooperative groups design combination trials from a menu rather than by bilateral pleading.
Hypothesis
Cooperative-group combination trials using formulary agents open at least twelve months faster than matched trials requiring bespoke supply negotiation.
Rationale
Drug supply is the single largest cause of delay in academic combination trials. A standing formulary shifts the negotiation to once per drug rather than once per trial.
What would test it
Expand an existing agent programme to a cohort of twenty agents across five companies, open to non-US cooperative groups, and time the next ten trials against historical controls.
Maturity
early clinical
Who has to act
policy
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Too many combinations to test · There are thousands of possible drug pairs and sequences. Trials can test a few dozen a year.
- Secrecy and intellectual property block collaboration · Companies with complementary drugs rarely test them together, and data that could answer questions stays locked up.