{"entity":{"id":"idea-reg-target-trial-emulation-pipeline","kind":"idea","name":"An automated pipeline emulating trials of every common drug against every cancer","aka":[],"tldr":"Millions of people take common drugs and some get cancer. Running standardised analyses across whole-country records could rank which old drugs deserve a real trial.","summary":"Nordic registries, UK CPRD and OpenSAFELY, US VA and Medicare, and Korean and Taiwanese national databases together cover hundreds of millions of people. Target trial emulation with active-comparator new-user designs, pre-registered protocols and negative-control outcomes can screen drug-cancer pairs systematically rather than one paper at a time. The proposal is an open, federated pipeline that runs a common protocol across databases for a defined library of drugs and cancer outcomes, publishes all results (including nulls) with bias diagnostics, and feeds a public prioritisation list for the repurposing fund.","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":[],"pathways":[],"terms":["real-world-evidence"],"trials":[],"people":[],"bottlenecks":["b-generic-repurposing","b-real-world-evidence"],"keyPapers":["paper-pantziarka-ecancermedicalscience"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"The pipeline identifies at least five drug-cancer pairs with concordant protective associations across three or more independent databases and negative-control checks within two years, and at least one enters a randomised trial.","rationale":"Single-database observational studies have produced many false leads; federated, pre-registered, multi-database analysis with shared code is the only way to separate robust signals from artefacts at scale.","test":"Build the pipeline for 50 drugs and 10 cancers across four databases, publish concordance results, and compare with known positives (aspirin-colorectal) and known negatives (metformin-breast).","maturity":"preclinical-evidence","actor":"data","cost":"medium","horizonYears":3},"route":"/ideas/idea-reg-target-trial-emulation-pipeline/","neighbours":{"term":[{"id":"real-world-evidence","kind":"term","name":"Real-world evidence","route":"/terms/real-world-evidence/"}],"bottleneck":[{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}],"paper":[{"id":"paper-pantziarka-ecancermedicalscience","kind":"paper","name":"The Repurposing Drugs in Oncology (ReDO) Project","route":"/key-papers/paper-pantziarka-ecancermedicalscience/"}]}}