OnCo
ideasIdea

Barcode patient-derived tumours to watch which clones win under each drug

Tag every cell in a patient's lab-grown tumour with a unique DNA label, give it a drug, and read the labels to see which cells survive. This predicts which resistant clone will emerge.

Lentiviral cellular barcoding of organoids or PDX models allows quantitative clonal tracking under therapy. Applied to patient avatars before treatment, it would measure the pre-existing resistant clone fraction and fitness under candidate drugs, prioritising combinations that suppress all high-fitness clones rather than the bulk.

Hypothesis
Barcoded avatar clonal dynamics predict the dominant resistance clone found in the patient's progression biopsy in most cases, and drug combinations chosen to suppress all barcoded winners extend avatar time-to-regrowth compared with bulk-response-chosen combinations.
Rationale
Barcoding studies in cell lines and PDX (for example in breast and lung models) show that resistance often arises from rare pre-existing clones whose identity is stable and predictable, not from random de novo events.
What would test it
Barcode 30 patient-derived models with matched clinical follow-up, treat with the patient's actual regimen, and compare the barcoded winner genotype with the patient's progression biopsy.
Maturity
preclinical evidence
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks

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