{"entity":{"id":"idea-tr2-factorial-adjuvant-generics","kind":"idea","name":"Factorial trials that test several cheap generics at once in the adjuvant setting","aka":[],"tldr":"One large trial can test aspirin, a statin, metformin and exercise at the same time by randomising each separately, answering four questions for the price of one.","summary":"A 2x2x2 factorial randomises each patient to each intervention independently, so main effects of several low-cost interventions are tested with the same participants. The Add-Aspirin trial and the earlier ATAC-style factorials show feasibility. Generic repurposing candidates have no sponsor, so factorial efficiency is the only way many will ever be tested.","asOf":"2026-09-08","links":[{"label":"Add-Aspirin trial","url":"https://www.addaspirintrial.org/"}],"tags":[],"related":["cruk","idea-tr2-perpetual-platforms"],"cancers":["colorectal"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-combination-space","b-generic-repurposing"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A factorial adjuvant trial of three generics in colorectal cancer will report main effects for all three with adequate power at a per-question cost below one third of separate trials.","rationale":"Interventions with different mechanisms rarely interact strongly; factorial designs exploit this. Cooperative groups have the infrastructure.","test":"Design and fund a 2x2x2 factorial in stage III colon cancer (for example aspirin, a statin and vitamin D) with disease-free survival as the primary endpoint.","maturity":"early-clinical","actor":"research","cost":"large","horizonYears":7},"route":"/ideas/idea-tr2-factorial-adjuvant-generics/","neighbours":{"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"}],"idea":[{"id":"idea-tr2-perpetual-platforms","kind":"idea","name":"A perpetual platform trial in every major cancer, funded as infrastructure","route":"/ideas/idea-tr2-perpetual-platforms/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"bottleneck":[{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-combination-space","kind":"bottleneck","name":"Too many combinations to test","route":"/bottlenecks/b-combination-space/"}]}}