OnCo
ideasIdea

A public registry of cancer treatments that were later shown not to work

Keep a running, well-documented list of cancer practices and approvals that were reversed by later evidence, so the pattern of mistakes is visible and teachable.

Medical reversals (for example high-dose chemotherapy with stem-cell rescue in breast cancer, several accelerated approvals later withdrawn, bevacizumab in breast cancer) are scattered across the literature. A curated registry with, for each reversal, the original evidence, the reversing trial, the time to reversal, the patients exposed, and the design features that allowed the error would inform regulators and teach trainees.

Hypothesis
Analysis of the registry will identify recurring design features (single-arm evidence, surrogate endpoints, small effect sizes) that predict reversal, and regulators will cite these features in subsequent approval decisions.
Rationale
Prasad and colleagues' reviews of reversals in general medicine changed thinking about evidence standards; oncology has enough reversals to learn systematically.
What would test it
Curate 100 oncology reversals with structured fields; publish the analysis of predictors; monitor citation in regulatory documents.
Maturity
speculative
Who has to act
data
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
  • Failures are hidden · Negative trials, failed drugs and abandoned programmes are rarely published, so the same mistakes are repeated.
  • Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.

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