Adult Pills for Children's Cancer

Approximately 400,000 children develop cancer each year. Survival in high-income countries exceeds 80%, but in most low- and middle-income countries it is below 30%. A substantial contributor to this gap is that only 34% of oral childhood cancer medicines are available in paediatric-friendly formulations. Clinicians in LMICs must crush adult tablets, split capsules, or compound liquid preparations — leading to imprecise dosing, chemical instability, and treatment failures. In 2025, WHO published its first-ever Target Product Profiles for child cancer drug formulations, covering six priority agents (cyclophosphamide, etoposide, mercaptopurine, methotrexate, procarbazine, temozolomide), but no manufacturer has yet developed products meeting these specifications.

The WHO Global Initiative for Childhood Cancer targets 60% survival in LMICs by 2030, but this is impossible without appropriate formulations. Medicine availability in LMICs is rated 9-46% vs. 67-100% in HICs. Liquid formulations — the default paediatric approach — are chemically unstable (cyclophosphamide degrades rapidly in water), require refrigeration unavailable in most LMIC supply chains, and have bulky packaging that increases shipping costs. Crushed adult tablets lead to medication errors: sedimentation in suspension, loss of active ingredient during crushing, and caregiver dosing mistakes. For cytotoxic agents, these errors have direct survival consequences.

The paediatric cancer formulation gap is fundamentally a market failure. Children represent a tiny fraction of cancer patients, and childhood cancers are rare and biologically distinct from adult cancers. Only 7% of pharma R&D in 2021 addressed needs of children under 12. Paediatric formulations typically lag adult formulations by up to a decade. Liquid preparations have been attempted but fail on stability, cold chain, and taste — over 90% of pediatricians report drug taste/palatability as the greatest barrier to treatment completion, and nearly 70% of anticancer APIs are bitter. Sweeteners used for taste masking absorb moisture and compromise tablet stability in humid tropical climates. The market is too small for pharmaceutical companies to invest in reformulation, too fragmented across LMICs to generate demand signals, and too specialized for generic manufacturers to enter without clear specifications.

The WHO TPPs specify dispersible tablets, orodispersible tablets (ODTs), or minitablets as preferred forms — stable in hot/humid climates with >24 month shelf life, no cold chain requirement, palatable taste profiles, and clear handling instructions for low-literacy settings. Orally disintegrating tablets that dissolve on contact with saliva are the emerging preferred platform: superior chemical stability vs. liquids and no water requirement. Research has shown that even very young children can safely swallow appropriately sized minitablets. The TPPs are explicitly designed as demand signals to generic manufacturers and product development partnerships, but converting specifications to marketed products requires pharmaceutical engineering investment that has not yet materialized.

A team could formulate and stability-test a dispersible tablet or minitablet version of one WHO priority drug (e.g., mercaptopurine or methotrexate) under accelerated tropical stability conditions (40 degrees C / 75% RH), evaluating dissolution profile, chemical stability, and taste masking. The engineering challenge is maintaining dose uniformity and chemical stability in a solid form that disintegrates rapidly in the mouth. Alternatively, a team could conduct a comparative dosing accuracy study: crushed adult tablet vs. prototype dispersible formulation vs. liquid preparation, measuring the variance in delivered dose across simulated caregiver preparation scenarios. Relevant disciplines: pharmaceutical sciences, chemical engineering, paediatric oncology, formulation science.