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Real treatment is a series of decisions: start with this, switch to that if it fails. Sequential multiple-assignment randomised trials test whole strategies by randomising patients again at each decision point.
SMART designs re-randomise participants at pre-specified decision points (e.g., at first progression or at ctDNA rise) to compare adaptive treatment strategies, estimating the best dynamic regime rather than the best single drug. Used in behavioural science and some leukaemia trials, rarely in solid tumours. Combined with a platform structure, this can address resistance-driven sequencing.
Shares Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Trial design, endpoints and cost, Prostate cancer.
Shares Drug resistance (primary and acquired), Acquired resistance to every therapy, Circulating tumour DNA (ctDNA).
Shares Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13, Circulating tumour DNA (ctDNA), Trial design, endpoints and cost, Prostate cancer.
Shares Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13, Circulating tumour DNA (ctDNA), Trial design, endpoints and cost, Colorectal cancer.
Shares Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13, Trial design, endpoints and cost.
Shares Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13, Trial design, endpoints and cost.
Shares Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Acquired resistance to every therapy, Prostate cancer.
Shares Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13, Trial design, endpoints and cost.