Failures are hidden

Companies shelve drugs that were safe but failed in the disease they tried. An oncology commons cataloguing discontinued assets with their mechanism, human pharmacokinetics, safety data and reasons for discontinuation, under template access terms, would let others test them where they might work, as NCATS and AstraZeneca schemes have shown.

Completed trials have stored samples. Testing a new biomarker on them with the plan written in advance is nearly as good as a new trial and far cheaper, but regulators have no clear route to accept it.

Create a proper, indexed journal that publishes failed experiments and trials quickly, with fees paid by funders so that there is no barrier to reporting failure.

Every failed cancer drug, experiment and trial gets recorded in one open ledger, so nobody repeats a failure that has already cost years and millions.

Failed laboratory experiments are rarely published, so other teams repeat them. A searchable place to deposit them would save years of duplicated work.

Drugs fail for distinct reasons: wrong target, drug never reached it, unacceptable toxicity, unselected population or poor trial design. A shared machine-readable taxonomy applied to every discontinued oncology programme in public pipeline databases would show where the system breaks, as AstraZeneca and Pfizer's own attrition analyses did.

Keep a running, well-documented list of cancer practices and approvals that were reversed by later evidence, so the pattern of mistakes is visible and teachable.

Thousands of cancer compounds that stopped development for portfolio rather than scientific reasons sit unused in university freezers and company archives. A public catalogue listing each asset's mechanism, stage, data, reason for stopping and licensing contact, with a standard research licence and a brokerage function, would let academic and non-profit developers adopt them.

Rate sponsors on whether they publish their results, share data and register outcomes honestly. Hospitals and patients can then prefer sponsors that behave well.

Most lab experiments that fail are never written up, so other labs repeat them. A simple, structured registry with a citable record for each failed experiment would stop the waste.

Every cancer trial's anonymised patient-level data would go into one trusted repository within eighteen months of completion, with a single access committee, so researchers can re-analyse, pool and learn from trials that today stay locked up.

Sometimes a treatment must be designed for a single patient. Agreeing in advance what evidence and safety checks are needed would make that fast, fair and learnable.

For each drug target, show how many programmes have been tried against it and how many failed, so new teams know what they are up against.

US law already requires trial results to be posted within a year and allows fines of over ten thousand dollars a day. Almost no fines have ever been issued. Start issuing them.

When a study is retracted, everything built on it should get a warning. Today, retracted cancer papers keep being cited and used for years.

Mine grant databases and the literature to find cancer types and questions with heavy burden and zero active projects, then publish the list so funders and scientists can go there.

Trials sometimes quietly swap the outcome they promised to measure for one that looks better. Software can compare the registered plan with the published paper and flag the switch.

Trials look at dozens of patient subgroups and some will look good by chance. A statistical method that pulls extreme subgroup results toward the overall result would make these claims more honest.

Pay a fixed reward to any lab that pre-registers and carefully repeats a heavily cited preclinical cancer finding, whatever the outcome, with a bonus for the first documented non-replication that passes methodological review. Today that work is unpaid and unpublished.

Trial results (hazard ratios, confidence intervals, subgroups, toxicities) would be deposited in a computer-readable form so they can be pooled, checked and used by software immediately.

Trial results are often presented at conferences months or years before the full paper appears, leaving doctors to act on slides. Require that the full structured results are published the same day.

Bowel cancer that has seeded the lining of the abdomen responds badly to drugs but well to a complete operation, and the heated chemotherapy that everyone added turned out to do nothing. What decides the outcome is whether the disease is found while it is still limited and whether the patient reaches a centre that can remove all of it.

Pay scientists a small bonus, added to their grant, when they post their results and data openly within six months of finishing an experiment, whether the result was positive or not.

Conferences headline the trials that worked, while most negative trials end up as posters or are never submitted. A standing plenary at ASCO, ESMO and AACR for negative and practice-reversing trials, with a discussant drawing lessons for design and biology, would make the failures impossible to miss.

Researchers report their successes to funders every year. Make them report their failures too, in a structured, searchable way.

When a public company announces a trial failure, it should be required to give the actual numbers, as it must for a success.

Before testing a drug in people, someone should systematically gather all the animal and laboratory evidence, including the studies that failed. Almost no cancer trial does this.

Drug candidates are tested for shrinking tumours, almost never for stopping spread. A standard spread test would find anti-metastatic drugs we are throwing away.

Drugs approved on early evidence come with follow-up obligations. One of them should be finding out how tumours escape the new drug.

The support cells that build a tumour's scaffolding come in several types: some protect the tumour, others restrain it. Treating all of them the same way explains past failures.

Ethics committees should check whether a sponsor has published the results of its previous finished trials before approving the next one.

Patients with brain tumours are sold ketogenic diets on the strength of mouse data and small feasibility studies. A single adequately powered trial with dietitian support would either prove it or let clinicians say clearly that it does not work.

When a trial fails, the company has little commercial reason to keep the detailed data secret. Make sharing it the default rather than something researchers must beg for.

Trial sites are paid per patient recruited, so nobody is paid to finish the study or report the answer. Shift part of the payment to completion and publication within a year.

If you join a cancer trial you should be told what it found, in plain words, within twelve months of the results, including if the treatment did not work.

Clinical trials must be registered before they start so that failures cannot be hidden. Animal studies used to justify human trials should follow the same rule.

Just as clinical trials must be registered before they start, studies using hospital data should be registered too, so the failed or unwelcome ones cannot quietly disappear.

Universities and cancer centres would change how they promote scientists, giving credit for finishing trials, sharing data, replicating others' work and publishing failures, not just for papers in famous journals.

When an aeroplane crashes, an independent report explains why so it does not happen again. When a cancer drug programme is abandoned, nothing is written. Change that.

When a regulator rejects a cancer drug, the reasons are usually secret. Publishing them everywhere would stop other countries and companies repeating the same mistakes.

Cancer drugs are often prescribed outside their approved use based on hope or small studies. Capturing outcomes of these uses would reveal which ones fail so they can be stopped.

Journals agree to publish a study based on the quality of the question and plan, before anyone knows the answer. That removes the pressure to make results look positive.

Every drug gallbladder cancer patients receive was tested in mixed bile duct trials where they were a subgroup. Requiring trials to pre-specify and publish gallbladder results, with a minimum number enrolled, would give the disease its own evidence at almost no cost.

Pancreatic tumours are mostly scar tissue. The first attempt to dissolve it, an enzyme given with chemotherapy to nearly 500 patients, shrank more tumours but did not lengthen life, and mouse work showed that stripping out the scar-forming cells made cancers worse. The proposal is to test drugs that change what the stroma does rather than remove it, in trials measured on survival.

Phase 3 trials are often launched on a small single-arm response-rate study with no comparison group, and most then fail. Requiring a randomised phase 2 with a concurrent control first, with exceptions only for large effects in refractory settings, would filter out weak drugs earlier.

Whether a drug gets into the brain is measured early in development but rarely published. Making that number public would show which existing drugs could treat brain disease.

Trials that fail still collected thousands of blood and tissue samples. Instead of being destroyed, they should be pooled so scientists can learn who might have benefited.

Pumping drugs slowly through fine tubes into a brain tumour can bypass the barrier, but the fluid often leaks away. Robotic placement and live scans would show where it actually goes.

For each type of laboratory model, keep a public record of how often its predictions came true in patients, so that researchers know which models to trust for which question.

Failed projects are not published because nobody has the time. Paying for a few months of writing would recover years of otherwise lost work.

Cancer cells need stiff, cross-linked tissue scaffolding to settle and grow in a new organ. Blocking the enzymes that build it may stop new colonies taking hold.

Large phase 3 trials often continue for years after interim data show the drug is unlikely to work. Pre-registering futility boundaries at 30 to 50 percent of the information, judged by independent committees and reported publicly, would stop them earlier, sparing patients and freeing money for better ideas.

Giving immunotherapy for a few weeks before surgery produces a tumour sample that shows exactly what the drug did. That is the fastest way to learn who responds.