# A public fund and label pathway to trial generic drugs against cancer

Source: https://onco.cc/ideas/idea-moon-generics-for-cancer-fund/  
OnCo record `idea-moon-generics-for-cancer-fund` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cheap old drugs such as aspirin, statins, metformin and beta-blockers show hints of cancer benefit but no company will pay for the trials. Create a public fund and a way to update their labels.

## Summary

Repurposing candidates with plausible mechanisms and observational signals rarely reach definitive trials because generic status removes the commercial incentive; the aspirin adjuvant trials (ADD-ASPIRIN) are a rare exception. The proposal is a dedicated public fund for pragmatic, registry-embedded randomised trials of generics in defined cancer indications, coupled with a regulatory pathway allowing third parties (academic groups, health systems) to obtain label updates, and payer commitments to reimburse on positive results.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: The fund completes at least ten definitive repurposing trials in a decade and delivers at least two new indications with population-level mortality impact at negligible drug cost.
- Rationale: The candidate list is long, the drugs are safe and cheap, and pragmatic trial designs make each question affordable; the missing element is an owner with an incentive.
- Proposed test: Fund five trials in the first tranche (for example beta-blockers in early breast cancer, statins in high-risk prostate cancer, metformin in specific contexts) with pre-registered designs and registry follow-up.
- Maturity: early-clinical
- Actor: policy

## Sources

- Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014): https://doi.org/10.3332/ecancer.2014.442

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/)
- key papers: [The Repurposing Drugs in Oncology (ReDO) Project](https://onco.cc/key-papers/paper-pantziarka-ecancermedicalscience/)
- ideas: [Take high-dose testosterone to phase 3, with progression-free survival through the second line as the primary endpoint](https://onco.cc/ideas/idea-prostate-bipolar-androgen-therapy-phase-3-on-pfs2/)

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