Medical Oncologist
Clinical Trials
Basket and Umbrella Trials: — A New Way to Match You to Treatment
Basket and umbrella trials match you to an experimental drug based on your tumour's mutation — not where the cancer started. This has opened trial access to patients with rare cancers who had no options under older trial designs.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Mutation decides eligibility — Your cancer's organ of origin does not determine whether you qualify — your tumour's genetic mutation does.
- Rarely a placebo — Most basket and umbrella trials compare the experimental drug against standard care, not a placebo.
- Drug is provided free — The experimental drug is provided at no cost through the trial. Some travel and test costs may apply.
- You can leave at any time — Withdrawing from a trial does not affect the rest of your cancer treatment.
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A basket trial tests one drug across several cancer types that share the same genetic mutation. Your cancer's origin does not decide your eligibility — your tumour's mutation does. This approach means patients with rare cancers can now join trials that would not have been open to them under older trial designs.
How do basket and umbrella trials compare to a standard trial?
| Feature | Standard trial | Basket trial | Umbrella trial |
|---|---|---|---|
| What is tested | One drug in one cancer type | One drug across multiple cancer types | Multiple drugs in one cancer type |
| How you qualify | Cancer type and stage | A specific mutation, regardless of cancer origin | A specific mutation within your cancer type |
| Placebo arm | Sometimes used | Rarely — usually compared against standard care | Rarely — drug is matched to your mutation |
| Experimental drug cost | Free through the trial | Free through the trial | Free through the trial |
| Who benefits most | Patients with common cancers and standard profiles | Patients with rare cancers or unusual mutations | Patients whose tumour has a known driver mutation |
How does a basket trial differ from an umbrella trial?
In a basket trial, one drug is tested across multiple cancer types that share a genetic mutation. Your cancer's starting point — thyroid, lung, bile duct — does not place you in or out. Your mutation does.
An umbrella trial works the opposite way. It takes one cancer type and tests multiple drugs under one protocol. Each patient is matched to a drug arm based on which mutation is driving their tumour.
Both designs exist because mutations do not respect cancer type boundaries, and older trial designs were not built to find that.
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Will there be a placebo, and what will the trial cost you?
In most basket and umbrella trials, there is no placebo arm. You will receive either the experimental drug or the current standard of care for your cancer. The trial coordinator will explain exactly which comparison is being made before you are asked to consent.
The experimental drug is provided at no cost through the trial. You may still face costs for travel, accommodation between visits, and some tests. Ask the trial team at the first meeting what is and is not covered, and whether any patient support fund exists.
You can withdraw from a trial at any point without it affecting the rest of your cancer treatment. Your care team remains the same whether you are in a trial or not.
How joining a basket or umbrella trial works, step by step
Biomarker testing
Your tumour tissue is tested for specific mutations. The result — not your cancer's organ of origin — determines which trials you may be eligible for.
Eligibility check
Your oncologist reviews open trial protocols against your mutation result. If a matching trial is enrolling, they will explain what it involves.
Consent discussion
A trial coordinator explains the protocol, what you will receive, what comparison is being made, and which costs are covered. You are given time to ask questions and to decide.
Enrolment and baseline tests
Once you consent, baseline tests confirm you meet all criteria. You are formally enrolled. The experimental drug is provided at no cost through the trial.
Treatment and monitoring
You attend visits on a defined schedule. Your response is measured and reported alongside others with the same mutation, which is how the evidence for these designs is built.
Did you know?
Basket and umbrella trials emerged partly because rare cancers were being excluded from conventional trials — they could not enrol enough patients to reach statistical significance.
By grouping patients by mutation rather than cancer type, these designs have opened access to experimental treatments for cancers that previously had no trial pathway at all.
Source: ESMO — European Society for Medical Oncology, on biomarker-driven trial design
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Common questions
Frequently asked questions
What is a basket trial in simple words?
A basket trial tests one drug across several different cancer types at the same time. What puts patients in the same basket is a shared genetic mutation that the drug targets — not where the cancer started. If you have a particular mutation in your thyroid cancer and someone else has the same mutation in their lung cancer, you may qualify for the same trial even though your diagnoses are different.
Will I get a placebo in a basket or umbrella trial?
Most basket and umbrella trials do not have a placebo arm. You will receive the experimental drug or be compared against the current standard treatment for your cancer. Some trials include a comparison arm with standard care. Ask the trial coordinator exactly what the comparison is before you consent — this is a normal question and they will answer it directly.
What does joining a clinical trial actually cost?
The experimental drug is provided at no cost through the trial. You may still have out-of-pocket costs for travel, accommodation between visits, and some tests — these vary by trial and by centre. Ask the trial team specifically what is covered, whether transport support is available, and whether the trial has a patient assistance fund. Do not assume everything is free, but do not assume you cannot afford it without asking first.
What is an umbrella trial, and how is it different from a basket trial?
An umbrella trial takes one cancer type and tests multiple drugs under one protocol, matching each patient to a drug based on their tumour's specific mutation. A basket trial does the reverse — one drug, multiple cancer types, all linked by the same mutation. Both designs use your molecular profile to decide where you fit, but the direction is different.
Can I leave a clinical trial if I change my mind?
Yes. You can withdraw at any point, for any reason, without giving an explanation. Your decision to leave will not affect the quality of your cancer treatment or your relationship with your care team. If your condition changes during a trial and another treatment becomes more appropriate, your team will discuss that with you. You are not locked in.