{"entity":{"id":"idea-bio1-adaptive-therapy-platform","kind":"idea","name":"A multi-cancer platform trial of adaptive (dose-holiday) therapy","aka":[],"tldr":"Instead of hitting a tumour with the maximum dose until it stops working, adjust the dose to keep the tumour small and let drug-sensitive cells suppress resistant ones. Test this properly across several cancers.","summary":"Adaptive therapy, in which dosing is modulated on a tumour burden marker to maintain a stable population of sensitive cells, extended time to progression in a pilot of abiraterone in prostate cancer. It has not been tested at scale or outside prostate. A platform trial would run adaptive versus continuous dosing arms in prostate (PSA), ovarian (CA-125) and melanoma (ctDNA) simultaneously with a shared evolutionary modelling core.","asOf":"2026-09-08","links":[{"label":"Zhang et al., adaptive therapy pilot in prostate cancer (Nat Commun 2017)","url":"https://www.nature.com/articles/s41467-017-01968-5"}],"tags":[],"related":["idea-desmoid-intermittent-dosing"],"cancers":["prostate","ovarian","melanoma"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["moffitt"],"pathways":[],"terms":["basket-umbrella-platform"],"trials":[],"people":[],"bottlenecks":["b-tumor-heterogeneity","b-dose-optimisation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Adaptive dosing at least doubles time to progression compared with continuous maximum tolerated dosing in at least one of three cancer settings while reducing cumulative drug exposure by 40 percent or more.","rationale":"Evolutionary theory and the prostate pilot agree that maintaining a sensitive population imposes a fitness cost on resistant cells; the failure of continuous dosing to prevent resistance is universal.","test":"Randomised phase 2 platform with 100 patients per disease cohort, primary endpoint time to progression, secondary cumulative dose and quality of life; pre-specified mathematical model calibration per patient.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":5},"route":"/ideas/idea-bio1-adaptive-therapy-platform/","neighbours":{"idea":[{"id":"idea-desmoid-intermittent-dosing","kind":"idea","name":"Intermittent or stop-and-restart nirogacestat in desmoid tumours","route":"/ideas/idea-desmoid-intermittent-dosing/"}],"cancer":[{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"ovarian","kind":"cancer","name":"Ovarian cancer","route":"/cancers/ovarian/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"institution":[{"id":"moffitt","kind":"institution","name":"Moffitt Cancer Center","route":"/institutions/moffitt/"}],"term":[{"id":"basket-umbrella-platform","kind":"term","name":"Basket, umbrella, and platform trials","route":"/terms/basket-umbrella-platform/"}],"bottleneck":[{"id":"b-tumor-heterogeneity","kind":"bottleneck","name":"Tumour heterogeneity and clonal evolution","route":"/bottlenecks/b-tumor-heterogeneity/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"roadmap":[{"id":"targeted-therapy-roadmap","kind":"roadmap","name":"Targeted therapy roadmap: imatinib → designed for resistance → the undruggable drivers fall","route":"/roadmaps/targeted-therapy-roadmap/"}]}}