Modern oncology has built highly efficient pathways for patent-protected innovation, but no equivalent machinery for evaluating and developing promising off-patent therapeutics. Herein, we frame ‘open-source oncology’ as a parallel public-interest infrastructure to test, authorize and implement credible generic agents. Designed to translate ownerless evidence into standard-of-care treatments, this framework applies the same scientific seriousness devoted to proprietary drugs, decoupling clinical value from commercial ownership. Liao, X. et al. Aspirin use, tumor PIK3CA mutation, and colorectal-cancer survival. N. Engl. J. Med. 367 , 1596–1606 (2012). Martling, A. et al. Low-dose aspirin for PI3K-altered localized colorectal cancer. N. Engl. J. Med. 393 , 1051–1064 (2025). Chia, J. W. K. et al. Aspirin after completion of standard adjuvant therapy for colorectal cancer (ASCOLT): an international, multicentre, phase 3, randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol. Hepatol. 10 , 198–209 (2025). Yaqub, S. et al. Aspirin as secondary prevention for colorectal cancer liver metastases (ASAC): a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial. J. Clin. Oncol. 43 , LBA3511 (2025). Pantziarka, P., Bouche, G., Meheus, L., Sukhatme, V. & Sukhatme, V. P.
Modern oncology has built highly efficient pathways for patent-protected innovation, but no equivalent machinery for evaluating and developing promising off-patent therapeutics. Herein, we frame ‘open-source oncology’ as a parallel public-interest infrastructure to test, authorize and implement credible generic agents. Designed to translate ownerless evidence into standard-of-care treatments, this framework applies the same scientific seriousness devoted to proprietary drugs, decoupling clinical value from commercial ownership.
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