Fig. 1

Suggested future clinical trial algorithm for hypoxia biomarker integration. Patients consent for pre-screening to investigate hypoxia biomarker expression in their cancer (detected either via hypoxia based imaging (i.e. pimonidazole) or validated hypoxia gene assays). Only patients that test positive for the hypoxia biomarker can then consent to the main study of a hypoxia modulating agent. Patients are stratified into disease specific cohorts based on the cancer type of interest (e.g. sarcoma, bladder, pancreas) due to the differences in cancer specific outcomes in these cohorts. If any hypoxia-biomarker cohort in this basket design shows sufficient signal of clinically relevant activity (e.g. durable clinical benefit) to warrant further investigation the cohort can then be expanded