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Give drug combinations before surgery and measure how much tumour remains at resection; that answer arrives in months. A standing neoadjuvant platform with a shared control arm, as I-SPY 2 runs in breast cancer, would test combinations quickly in lung, bladder, melanoma, head and neck and oesophago-gastric cancer.
I-SPY 2 established graduation of arms by pathological complete response in breast cancer. The same model applies to lung, bladder, melanoma, head and neck and oesophago-gastric cancer where neoadjuvant therapy is now standard. Each cancer needs a standing neoadjuvant platform with a shared control arm and pre-agreed rules for graduating an arm to a confirmatory trial.
Shares Major pathological response (MPR), NADINA, Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on.
Shares Basket, umbrella, and platform trials, Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on, Too many combinations to test, Trial design, endpoints and cost.
Shares Basket, umbrella, and platform trials, Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on, Too many combinations to test, Trial design, endpoints and cost.
Shares Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on, Trial design, endpoints and cost, Head and neck squamous cell carcinoma.
Shares Let the trial learn: response-adaptive allocation across many combination arms, Too many combinations to test, Trial design, endpoints and cost.
Shares Residual cancer burden (RCB), KEYNOTE-522, Pathologic complete response (pCR).
Shares Basket, umbrella, and platform trials, Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on, Too many combinations to test.
Shares Basket, umbrella, and platform trials, Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on, Trial design, endpoints and cost.