Prospective Predictions for Ongoing Immunotherapy Trials from a Structural Theory of Dissipative Systems

We publish prospective predictions for nine ongoing Phase III immunotherapy trials (~7,100 patients, five cancer types) and propose five new trials the field should consider. The predictions and proposals derive from a single structural principle: the effectiveness of a drug combination depends on how many distinct steps in the immune-tumour interaction it covers, not on how many drugs are given at the same step. Five of nine trials are predicted to fail because the experimental agent does not address a step that the existing regimen leaves open. One trial is predicted to succeed decisively because it covers three distinct steps across two mechanism layers. The five proposed trials apply the same coverage principle to identify the actual bottleneck in settings where immunotherapy currently fails — and it is never the checkpoint. All predictions are timestamped and falsifiable.