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In recent years, cancer drug randomised controlled trials (RCTs) have been criticised for employing a control arm treatment that is inferior or suboptimal to the existing standard of care.1 2 Using an inferior treatment as the control arm in an RCT undermines both the scientific validity and the ethics of trials and has been recognised as an important bias in cancer clinical trials by the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale3 as well as the Common Sense Oncology initiative.4