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Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.
Hundreds of licensed non-cancer drugs, including metformin, aspirin, statins, beta-blockers, antihistamines, antifungals and antihelminthics, have preclinical or observational anti-cancer signals, and the ReDO project has catalogued more than 300 of them. Because they are off-patent, no company will fund the phase 3 trials needed to change practice or the label, and academic funders have limited budgets for large pragmatic trials. When trials are run, results can go either way: metformin failed to improve survival in breast cancer (MA.32), while aspirin halved colorectal cancer in Lynch syndrome (CAPP2) and eflornithine, an old antiparasitic, was approved in 2023 for neuroblastoma maintenance after a single-arm trial with an external control. The regulatory route to a new indication for a generic, and the reimbursement of an off-label use, remain unclear in most countries, so even positive results diffuse slowly.
Offer a large cash prize to whoever proves, in a rigorous trial, that a cheap existing drug helps people with cancer live longer. Prizes pull effort towards neglected problems.
A Japanese trial found vitamin D supplements did not help everyone after digestive cancer surgery, but appeared to help a subgroup identified by a tumour marker. That subgroup deserves its own trial.
A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.
Instead of letting a company charge more for a newly proven use of an old drug, payers would pay a one-off reward and keep the price low for everyone.
Cheap generic versions of targeted cancer drugs like imatinib exist, but patients with rare tumours carrying the matching mutation often cannot get them. A structured programme would treat them and collect the evidence.
Sometimes a progression biopsy shows exactly which drug would help, but it is licensed for another cancer and cannot be obtained. A standing pathway would fix that.
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.
Someone must legally own a drug's licence to update its label and monitor safety. A non-profit could do this for old drugs proven to work in cancer that no company wants.
Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.
People with cirrhosis have a high risk of liver cancer, and those who happen to take statins seem to get it less often. A proper trial would settle whether statins should be prescribed for prevention.
Cheap old drugs such as aspirin, statins, metformin and beta-blockers show hints of cancer benefit but no company will pay for the trials. Create a public fund and a way to update their labels.
Old drugs like aspirin, statins and beta-blockers show hints of fighting cancer, but no company will pay to prove it. A dedicated public fund should.
The UK's RECOVERY trial answered questions about dexamethasone and other cheap COVID drugs within months by randomising tens of thousands of ordinary hospital patients with a two-page consent and routine-data follow-up. Cancer needs the same permanent platform to test generics such as statins, metformin, aspirin and propranolol added to standard care.
Create a way for a charity or university to get a cheap old drug officially approved for a new cancer use, with a few years of protection on that use so trial costs can be recovered without high prices.
If a cheap old drug could replace or reduce an expensive cancer treatment, health systems save money. Investors could fund the trial and be repaid from those savings if it works.
Cancer patients have had treatments delayed because basic chemotherapy drugs ran out. Keeping a national stockpile, like for flu antivirals, would prevent this.
Doctors often use cancer drugs outside their approved use based on a hunch or a small study. Record what happens every time so the hunches become evidence.
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.
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.
An old part of the immune system called complement can be hijacked by tumours to summon protective cells. Drugs that block it already exist for other diseases.
Sleeping cancer cells survive by recycling their own contents. An old malaria drug blocks that recycling and is being tested in people with no visible cancer but detectable residual cells.
The stress of an operation may help stray cancer cells survive and settle. A few days of two cheap old drugs around surgery might reduce that risk.
A randomised placebo-controlled trial at Tata Memorial found that 2.5 mg of olanzapine daily, a cheap antipsychotic pill already used for chemotherapy nausea, improved appetite and weight gain in patients starting chemotherapy for advanced stomach, lung and hepatopancreatobiliary cancers. A multinational confirmatory trial is needed before guidelines and labels adopt it.
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.
The evidence for old drugs against cancer is scattered across hundreds of papers. Assembling it into the format regulators and funders need is cheap and would speed decisions.
A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately.
Only the manufacturer can ask regulators to add a new use to a drug's label, and generic makers have no reason to. Universities and charities should be allowed to apply.
A cheap blood pressure drug may soften the dense scar tissue around pancreatic tumours so chemotherapy and immune cells can get in. Early trials look encouraging.
A cheap, old antipsychotic at a low dose is one of the best anti-sickness drugs for chemotherapy. Make sure every cancer unit in the world uses it.
Preparing a regulatory filing requires expensive specialist software and consultants. Free, open tools would let universities and small generic firms file in more countries.
Fund trials of old, cheap drugs with anti-cancer signals without seeking patents, and have generic makers produce them, so cost, not profit, decides whether patients get them.
Even when a trial proves a cheap old drug helps, insurers may refuse to pay because it is not licensed for cancer. A standing promise to pay would remove that fear.
Surgical stress releases catecholamines and prostaglandins that suppress anti-tumour immunity and help metastatic cells seed. Phase 2 trials of a five-day course of propranolol plus etodolac around breast and colorectal surgery shifted tumour markers of metastasis and immune suppression in the right direction; both drugs cost cents, and a publicly funded phase 3 is the missing step.
AI systems claim to find new uses for old drugs, but their predictions are rarely tested fairly. Publish their cancer predictions in advance and score them against trial results.
Antibiotics given in the weeks before immunotherapy are linked to much worse results. A simple stewardship rule could preserve benefit at no cost.
Patients who happened to take common allergy pills during immunotherapy seemed to live longer in a large records study. A simple randomised trial would show whether the pills really help.
The big metformin cancer trial failed after years and millions, despite strong observational hints. Cheaper checks on causality should be passed before funding the next one.
Cancer cells in the blood wrap themselves in platelets as camouflage. Aspirin may remove that cloak, and it is cheapest to test in the patients at highest risk of relapse.
Giving men with castration-resistant prostate cancer large doses of the hormone the treatment has spent years removing makes a third of them respond, and makes half of them respond again to the drug that had stopped working. It has never been taken to a definitive trial, partly because the endpoint that shows the benefit is not the one trials usually use.
People who eat more fibre appear to respond better to immunotherapy, while some probiotic supplements may do the opposite. A proper trial would settle it.
Nobody funds trials of old drugs because competitors can sell the result for free. A short exclusive period for the new use, like the one given for children's studies, would change that.
Certain vaccines and fungal sugars reprogramme the bone marrow so it produces more aggressive immune cells for months. That could be used before immunotherapy.
Generic imatinib and abiraterone can cost patients hundreds of dollars a month through insurance yet be sold at cost plus a fixed markup by transparent pharmacies; making that the default channel for oral cancer generics would save patients and plans money.
Indian trials have shown that tiny daily doses of old oral chemotherapy drugs can help patients with head and neck cancer at a cost of a few dollars a month. These regimens should be proven and adopted worldwide.
For colon cancer survivors, a prescribed, supported exercise programme is now an evidence-based treatment with a survival benefit comparable to many drugs. Health systems will need to fund exercise consultants as they fund chemotherapy. The trial does not tell us whether unsupervised advice achieves the same.
A measured position a patient can take to their oncologist: the drug is being tested properly, and until those tests report, it is not a treatment.
One bottleneck page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
People with Lynch syndrome should be offered daily aspirin, which roughly halves bowel cancer risk with a delayed and durable effect. Whether a lower dose (as tested in CAPP3) is as effective, and whether the finding extends to the general population, are separate questions.
A demonstration that a drug that has stopped working can be made to work again by changing the environment the tumour has adapted to, rather than by changing the drug. It is the strongest clinical evidence in prostate cancer for treating resistance as something reversible.
Men diagnosed with prostate cancer that has already spread, or that is locally advanced and high risk, should start abiraterone (or another androgen-receptor pathway inhibitor) at the same time as testosterone suppression rather than waiting for resistance. This roughly halves the risk of death over several years. The same platform later showed that docetaxel chemotherapy and, in high-volume metastatic disease, triple therapy also help, and that abiraterone benefits men with high-risk disease treated with radiotherapy.
One bottleneck page and 21 idea pages on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
The trial did not change practice, but it established the idea that the days around surgery are a window in which cheap interventions might reduce metastasis, a line the same group pursued to a positive result with peritumoral lidocaine in 2023. It is a reminder that subgroup findings need confirmation, which is still awaited.
Shares Ivermectin treatment for gynecologic cancers: hope versus hype, The University of Kansas Cancer Center, ICONIC: ivermectin combined with immune checkpoint inhibition in cancer (University of Florida phase 2), Ivermectin with balstilimab or pembrolizumab in metastatic triple-negative breast cancer (Cedars-Sinai phase 1/2).
Shares Confirm low-dose olanzapine for appetite and weight in advanced cancer worldwide, Single-injection depot progesterone before surgery and survival in operable breast cancer, Validate low-cost metronomic oral regimens in phase 3 and carry them into guidelines, A platform trial of very-low-cost metronomic chemotherapy in LMIC common cancers.
Shares Payers pre-commit to cover off-label generics when a definitive trial is positive, Three years of indication-specific exclusivity for proving a new cancer use of an old drug, A $50 million prize for the first off-patent drug proven to extend cancer survival, A repurposing label pathway with short exclusivity that non-profits can hold.
Shares Ivermectin treatment for gynecologic cancers: hope versus hype, ICONIC: ivermectin combined with immune checkpoint inhibition in cancer (University of Florida phase 2), High-dose intravenous vitamin C, Fenbendazole, ivermectin and other internet 'repurposed cures'.
Shares Perioperative beta-blocker plus COX-2 inhibitor to reduce metastasis after surgery, Cheap perioperative beta-blocker plus anti-inflammatory to blunt surgical stress, Strip the platelet coat off travelling tumour cells in ctDNA-positive patients, Peritumoral lidocaine before breast cancer surgery (Tata Memorial).