ideasIdea
Fund a biopsy at progression, every time, as standard care
When a treatment stops working, the tumour is rarely re-sampled, so nobody learns why. Paying for a biopsy at that moment would build the missing map of resistance.
Resistance mechanisms are known for only a minority of progressions because the sample is never taken: reimbursement is unclear, the patient is unwell, and there is no trial slot. A funded pathway would pay for a paired tissue and plasma sample at every progression on a targeted agent, with rapid sequencing, a mechanism-matched treatment recommendation returned to the clinician, and deposition into a shared database.
Hypothesis
A funded resistance-biopsy pathway raises the proportion of progressions with a defined mechanism from a small minority to over half, and identifies an actionable alteration in a fifth of cases.
Rationale
Where such programmes exist in research settings, mechanism yield is high and actionable findings are common; the barrier is reimbursement and logistics rather than science.
What would test it
Coverage-with-evidence pilot in one health system for 1,000 progressions: measure mechanism yield, actionability, uptake of matched therapy and cost per actionable finding.
Maturity
early clinical
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
- Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.