# One global rare cancer network with n-of-1 and Bayesian trial frameworks

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

## TL;DR

Rare cancers are collectively common but each is too rare for normal trials. Link every rare cancer patient worldwide into one network with registries and trial designs built for small numbers.

## Summary

Rare cancers make up roughly a quarter of cancer diagnoses and have worse survival; each is too infrequent for conventional trials and expertise is scattered. Networks such as EURACAN and the International Rare Cancers Initiative show partial solutions. The proposal is a global federated rare cancer network: a single patient-facing registration and referral pathway, standardised molecular workup, a shared registry with outcomes, and pre-agreed trial frameworks (Bayesian borrowing across related histologies, n-of-1 crossover designs, external control arms from the registry) accepted by regulators for approval decisions.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: The network doubles the number of rare cancer patients in trials and achieves at least five regulatory approvals in rare histologies within a decade using its trial frameworks.
- Rationale: Aggregating small populations across borders is the only route to adequate sample sizes, and regulators have signalled openness to novel designs when data infrastructure is credible.
- Proposed test: Launch in sarcoma subtypes and rare gastrointestinal cancers; measure registration coverage, time to trial availability and approvals using network-generated evidence.
- Maturity: early-clinical
- Actor: research

## Sources

- Bottleneck evidence (Rare and paediatric cancers without markets): Gatta et al., Rare cancers are not so rare: the rare cancer burden in Europe (EJC 2011): https://doi.org/10.1016/j.ejca.2011.08.008

## Connected records

- cancers: [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Mesothelioma](https://onco.cc/cancers/mesothelioma/), [Neuroendocrine tumours](https://onco.cc/cancers/neuroendocrine/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- companies: [EORTC](https://onco.cc/companies/curie-nki-eortc/)
- terms: [Basket, umbrella, and platform trials](https://onco.cc/terms/basket-umbrella-platform/)
- bottlenecks: [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/), [Regulatory divergence between regions](https://onco.cc/bottlenecks/b-regulatory-fragmentation/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- key papers: [Rare cancers are not so rare: the rare cancer burden in Europe](https://onco.cc/key-papers/paper-gatta-eur-j-cancer/)

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