A classic 3 + 3 study design to find the Maximum Tolerated Dose (MTD) may be straightforward and rule-based, but that does not equate to “simple.” One U.S.-based study team responsible for testing an oncology drug on two continents, quickly realised this. They were dreading the prospect of more than two years of complicated tracking and decision making, most especially because they’d have to be available throughout the night to manage drug and dose assignments in different time zones. Theoretically, their tracking could be done on a spreadsheet, but at what cost? The solution was to let IXRS® handle it all automatically, while the study team slept.