The problem

Whilst improvements in patient survival have been realized for a number of haematological and solid malignancies in the last 30 years, new efficacious systemic anti-cancer treatments are still needed. The current, widely used drug development paradigm is often associated with a poor conversion rate from experimental to licensed drug. This process involves a significant investment of resources from sponsors, investigators and patients and to date has only lead to a limited chance of success. At present there are in excess of 800 anti-cancer agents in development and less than 10 new FDA approvals each year [1]. In order to address this problem there has been considerable debate concerning the best trial methodology to rationalize this process, with discussion of the timing, sequence and design of appropriate trials [2]. At present in many tumour types including breast, lung, renal cell and prostate cancer, the pipeline of new agents is crowded. In order therefore to use the available financial and patient resource wisely, it is crucial to identify the key important pathways in onco-genesis that in turn may help and prioritize the drugs with the most promise.

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