OnCo
ideasIdea

An open engine that ranks every drug pair by predicted synergy before anyone runs a trial

Use existing cell-line and organoid data to score thousands of drug pairs, publish the ranking openly, and only test the top of the list in people.

DepMap dependency screens, the NCI ALMANAC pairwise matrix and published organoid drug-response sets contain far more combination signal than has been mined. A public model that predicts synergy and, critically, therapeutic window (tumour versus normal-cell toxicity) for each pair in each molecular context would give trialists a prioritised shortlist. Models should be scored prospectively against every new combination readout.

Hypothesis
Combinations in the top decile of the published ranking will show randomised phase 2 success (meeting primary endpoint) at least twice as often as combinations chosen by conventional mechanistic argument.
Rationale
The DREAM AstraZeneca-Sanger synergy challenge showed predictive signal in cell lines. NCI ALMANAC identified bortezomib plus clofarabine from a systematic screen. The failure has been that rankings are not published, not maintained and not scored against outcomes.
What would test it
Publish rankings for all pairs of approved oncology drugs; register predictions; score them against every randomised combination readout over three years, reporting calibration publicly.
Maturity
preclinical evidence
Who has to act
data
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks

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