{"entity":{"id":"idea-reg-guideline-fast-track-repurposed","kind":"idea","name":"A guideline fast track for repurposed drugs with phase 3 evidence but no manufacturer","aka":[],"tldr":"Guidelines usually wait for a drug to be licensed for a use before recommending it. For old drugs no one will license, guidelines should act directly on trial evidence.","summary":"Guideline bodies (NCCN, ESMO, NICE) do recommend off-label uses but often slowly and inconsistently for interventions without a sponsor to submit evidence. The proposal is a standing fast-track procedure in major guideline organisations, triggered automatically by publication of a registration-quality randomised trial of an off-patent drug, with a decision within six months, an explicit statement of the recommendation's reimbursement implications, and a mechanism for payers to adopt it in the absence of a label.","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":["nccn","esmo-guidelines"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["esmo","asco"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-generic-repurposing","b-knowledge-diffusion"],"keyPapers":["paper-pantziarka-ecancermedicalscience"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Fast-tracked repurposed interventions reach guideline recommendation within six months of publication (versus a historical median of two or more years) and prescribing uptake within two years exceeds 50% of eligible patients.","rationale":"For off-patent drugs, guidelines rather than labels are the practical gateway to routine use and reimbursement; making the pathway explicit removes an arbitrary disadvantage relative to sponsored drugs.","test":"Audit the time from publication to guideline inclusion for the last ten positive repurposing trials; implement the fast track in one guideline body and measure the next five.","maturity":"speculative","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-reg-guideline-fast-track-repurposed/","neighbours":{"collection":[{"id":"esmo-guidelines","kind":"collection","name":"ESMO Clinical Practice Guidelines & MCBS","route":"/collections/esmo-guidelines/"},{"id":"nccn","kind":"collection","name":"NCCN Guidelines","route":"/collections/nccn/"}],"institution":[{"id":"asco","kind":"institution","name":"American Society of Clinical Oncology (ASCO)","route":"/institutions/asco/"},{"id":"esmo","kind":"institution","name":"European Society for Medical Oncology (ESMO)","route":"/institutions/esmo/"}],"bottleneck":[{"id":"b-knowledge-diffusion","kind":"bottleneck","name":"Knowledge reaches practice too slowly","route":"/bottlenecks/b-knowledge-diffusion/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-pantziarka-ecancermedicalscience","kind":"paper","name":"The Repurposing Drugs in Oncology (ReDO) Project","route":"/key-papers/paper-pantziarka-ecancermedicalscience/"}]}}