{"entity":{"id":"idea-reg-factorial-addon-arms-cooperative-trials","kind":"idea","name":"Add a cheap-drug factorial arm to every cooperative-group adjuvant cancer trial","aka":[],"tldr":"Large adjuvant trials already follow thousands of patients for years. Adding a second randomisation to a cheap old drug would answer repurposing questions almost for free.","summary":"Factorial designs randomise the same patients to two independent questions, sharing recruitment, follow-up and infrastructure. Add-Aspirin ran as a standalone trial; embedding similar questions as second factors in cooperative-group adjuvant trials (breast, colorectal, lung, prostate) would multiply the number of repurposing questions answered at a small marginal cost. The proposal is a policy by public trial funders (NCI cooperative groups, CRUK, EORTC) that every new large adjuvant trial include, where feasible, a factorial randomisation to a prioritised off-patent candidate, with a central committee selecting candidates and monitoring interactions.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014)","url":"https://doi.org/10.3332/ecancer.2014.442"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["nci","cruk"],"pathways":[],"terms":["neoadjuvant-adjuvant"],"trials":[],"people":[],"bottlenecks":["b-generic-repurposing","b-trial-design"],"keyPapers":["paper-pantziarka-ecancermedicalscience"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Factorial add-ons answer at least one repurposing question per two adjuvant trials at less than 10% additional cost per trial, without compromising the primary question's power or recruitment.","rationale":"The main cost of an adjuvant trial is following patients for years; a second factor uses that investment twice. Interaction between factors is a manageable statistical risk when candidates are chosen for independent mechanisms.","test":"Embed factorial arms in the next three cooperative-group adjuvant trials and report recruitment, cost increment and analysability against the groups' previous trials.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":6},"route":"/ideas/idea-reg-factorial-addon-arms-cooperative-trials/","neighbours":{"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"},{"id":"nci","kind":"institution","name":"National Cancer Institute (NIH)","route":"/institutions/nci/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"bottleneck":[{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"paper":[{"id":"paper-pantziarka-ecancermedicalscience","kind":"paper","name":"The Repurposing Drugs in Oncology (ReDO) Project","route":"/key-papers/paper-pantziarka-ecancermedicalscience/"}]}}