OnCo
ideasIdea

Standing reflex biomarker panels per tumour type, run without an oncologist's order

For each cancer type, agree the set of stains and tests that are always needed, and have the lab run them automatically on diagnosis rather than waiting for someone to ask.

Beyond genomic profiling, many predictive tests (PD-L1, mismatch repair, HER2 in gastric and colorectal cancer, HPV/p16 in oropharynx) are ordered inconsistently, delaying or denying effective therapy. A national or hospital-level reflex protocol per tumour type, maintained against current guidelines, would make testing complete and timely. Reflex mismatch-repair testing in colorectal cancer for Lynch syndrome is an established precedent.

Hypothesis
Reflex panels will raise completeness of guideline-required predictive biomarkers at first oncology visit to above 95% and cut time from diagnosis to first-line treatment decision by at least a week.
Rationale
Testing that depends on an individual clinician remembering to order it will always be incomplete; making it a laboratory default removes the failure mode.
What would test it
Implement reflex panels in a regional laboratory network and audit completeness, turnaround, and downstream therapy use before and after.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
1
Bottlenecks it attacks

Connected

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cancers

4
Colorectal cancerGastric & gastro-oesophageal junction cancerHead and neck squamous cell carcinomaNon-small-cell lung cancer

terms

2
Combined positive score (CPS)Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)

ideas

1
Pathologists order genomic profiling automatically at diagnosis of advanced cancer

bottlenecks

2
Biomarkers are not validated or standardisedFragmented care and guideline gaps