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When the standard treatment has been given to thousands of similar patients in earlier trials, a new trial could randomise fewer people to it and lean on that history, as long as the old data still matches.
Hybrid control designs use Bayesian dynamic borrowing (power priors, meta-analytic-predictive priors, commensurate priors) from curated historical control arms and real-world cohorts to reduce concurrent control allocation to 1:2 or 1:3 while retaining randomisation. Borrowing is down-weighted automatically when the concurrent controls diverge from history. The FDA Complex Innovative Design programme has reviewed such designs; oncology uptake is limited.
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Shares Trials enrol too few, too slowly, Trial design, endpoints and cost.