# An ARPA-style programme to develop supportive-care drugs nobody else will

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

## TL;DR

A supportive-care ARPA would be a well-funded, milestone-driven agency that develops drugs for nausea, nerve damage, mouth sores, fatigue and brain fog from cancer treatment, which the market has largely ignored.

## Summary

Supportive-care drug development has stalled: the last major antiemetic class (NK1 antagonists) is over twenty years old, there is no approved preventive for chemotherapy-induced neuropathy, and fatigue and cognitive impairment have no pharmacological standard. The proposal is a dedicated programme (public or philanthropic, ARPA-H style) funding target discovery, repurposing screens and pragmatic trials of supportive-care agents, with pull incentives (advance purchase, priority review vouchers) for approvals.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A ten-year, well-funded programme delivers at least three new approved supportive-care agents and measurably reduces dose reductions and discontinuations for toxicity across common regimens.
- Rationale: Supportive-care drugs are generics-priced and off-patent-adjacent, so private investment is weak although the population is enormous and the endpoints are fast. Focused public programmes have succeeded where markets failed (antibiotics, neglected diseases).
- Proposed test: Fund a first cohort of five programmes (neuropathy prevention, mucositis, cachexia, fatigue, cognition) with 3-year go/no-go milestones; success is two reaching phase 3 with positive phase 2 signals.
- Maturity: speculative
- Actor: philanthropy

## Sources

- ARPA-H: https://arpa-h.gov/

## Connected records

- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- ideas: [Give survivorship interventions a shared control arm](https://onco.cc/ideas/idea-rejuv-survivorship-platform-trial/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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