OnCo
ideasIdea

An open atlas of collateral sensitivity for every approved targeted drug

When a tumour evolves resistance to one drug, it sometimes becomes weaker against another. Map these trade-offs systematically so doctors can pick the next drug to exploit them.

Collateral sensitivity is well characterised in antibiotics and shown in a few oncology examples (MEK-inhibitor resistance sensitising to certain agents, ABL inhibitor rotation in CML). A systematic programme would evolve resistance to each approved targeted agent in dozens of models, screen the resistant derivatives against the full pharmacopoeia, and publish a public sensitivity map to inform sequencing trials.

Hypothesis
For most approved targeted agents, at least one collateral sensitivity with a greater than three-fold shift will be reproducible across models and will translate into a sequencing rule that prolongs second-line response in a trial.
Rationale
Resistance carries costs. Antibiotic collateral sensitivity maps have already guided cycling regimens; oncology has the models and drugs but has never done the systematic screen.
What would test it
Two-year screen across 20 drugs and 200 models with independent replication of top hits; then a randomised second-line sequencing trial in the setting with the strongest signal.
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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