DRUP: a basket trial does not make all biomarkers equally strong
Cohorts in the Dutch DRUP programme produced sharply different outcomes. The contrast is not evidence that actionability tiers do not matter; its own later analysis argues that strong biological and prior clinical evidence tracked with the better-performing targets.
Written retrospectively and published on August 3, 2026.
Background reading, not clinical guidance. This describes published research; it is not a recommendation for any individual case, and the cited studies may have been superseded.
Drug rediscovery trials test approved cancer drugs outside their usual indication when a tumour has a potentially relevant molecular feature. They are an efficient way to learn, but their inclusion rule is broader than a guarantee that every drug–biomarker pair is equally convincing.
DRUP’s tumour-agnostic cohort of microsatellite-instable tumours treated with nivolumab reported a clinical benefit rate of 63%. By contrast, palbociclib or ribociclib alone in cancers with cyclin D–CDK4/6-pathway alterations had a 16-week clinical benefit rate of 15% and an objective response rate of 0% in a pooled DRUP and MoST analysis.
Keep the endpoints straight
Both headline percentages are clinical benefit rates, not response rates. They count either a confirmed response or stable disease lasting at least sixteen weeks. Calling the 15% figure a response rate would turn a zero-response cohort into a misleadingly positive one.
The lesson is not that formal evidence levels fail to predict outcomes. A 2026 DRUP analysis concluded that high-performing targets shared strong biological rationale and prior clinical activity, whereas some weaker biomarkers had modest activity. Equal access to a basket-trial cohort is not equal evidence.
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