{"entity":{"id":"idea-tr1-public-de-escalation-trial-fund","kind":"idea","name":"A public fund for trials that test less treatment","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"The Anticancer Fund","url":"https://www.anticancerfund.org/"},{"label":"NIHR","url":"https://www.nihr.ac.uk/"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["trastuzumab","pembrolizumab"],"companies":[],"institutions":["cruk"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-trial-design","b-toxicity-qol","b-incentive-misalignment"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"large","horizonYears":5},"route":"/ideas/idea-tr1-public-de-escalation-trial-fund/","neighbours":{"drug":[{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"},{"id":"trastuzumab","kind":"drug","name":"Trastuzumab","route":"/drugs/trastuzumab/"}],"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"}],"bottleneck":[{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}]}}