# A public fund for trials that test less treatment

Source: https://onco.cc/ideas/idea-tr1-public-de-escalation-trial-fund/  
OnCo record `idea-tr1-public-de-escalation-trial-fund` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

No company will pay to find out whether six months of its drug works as well as twelve. A dedicated public fund would pay for those trials, which save patients side effects and health systems money.

## Summary

A ring-fenced fund (national research agency or philanthropic) that only supports randomised non-inferiority trials of shorter duration, lower dose, fewer cycles, omitted components or less frequent dosing of approved therapies, with a standing statistical and design core and pre-agreed non-inferiority margins co-developed with patients. Precedents: PERSEPHONE (6 vs 12 months trastuzumab), SOLD, and low-dose abiraterone; funders such as the UK NIHR HTA programme and the Anticancer Fund have supported some.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Each dollar invested in de-escalation trials will return multiples in avoided treatment cost within five years of read-out, and at least a third of funded trials will change guidelines.
- Rationale: The incentive gap is structural: de-escalation reduces revenue. The trials are cheap relative to the drug spend they interrogate, and several have already changed practice.
- Proposed test: Fund ten trials over five years and audit guideline changes, avoided drug costs and patient-reported toxicity differences against the fund's outlay.
- Maturity: being-tested-at-scale
- Actor: philanthropy

## Sources

- The Anticancer Fund: https://www.anticancerfund.org/
- NIHR: https://www.nihr.ac.uk/

## Connected records

- drugs: [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- 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/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)

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