Biopsy the one lesion that is growing while the others shrink
When a scan shows most tumours shrinking but one growing, that odd lesion holds the escape mechanism. Sampling it, and treating it locally, should be routine.
Mixed responses are common on targeted therapy and immunotherapy, yet the discordant lesion is rarely biopsied and the systemic drug is often abandoned. The proposal is a protocolised pathway: automated lesion-level response tracking on CT, biopsy of the outlier, targeted sequencing, and continuation of systemic therapy with local ablation or SBRT to the outlier lesion.
- Tumour heterogeneity and clonal evolution · A tumour is many tumours. Treatments that kill most cells leave the rest to grow back, changed.
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
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not linked directly; found by shared links- TermOligoprogression
Shares Oligometastatic disease, Tumour heterogeneity and clonal evolution, SBRT / SABR (stereotactic radiotherapy), Non-small-cell lung cancer.
- IdeaSwitch drugs at maximum response, not at relapse
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Melanoma, Non-small-cell lung cancer.
- IdeaPause a failed drug so the tumour becomes sensitive to it again
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Melanoma, Non-small-cell lung cancer.
- IdeaRe-test the metastasis, not the old primary, before every change of treatment
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Comprehensive genomic profiling, Non-small-cell lung cancer.
- IdeaLook for the resistant sub-population before the first dose
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Comprehensive genomic profiling, Non-small-cell lung cancer.
- IdeaSlow the tumour's mutation engine with APOBEC inhibitors during targeted therapy
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Non-small-cell lung cancer.
- IdeaA regulatory endpoint for drugs that block spread, not tumours
Shares RECIST, Oligometastatic disease.
- InstitutionHealthCare Global Enterprises
Shares SBRT / SABR (stereotactic radiotherapy), Comprehensive genomic profiling, Non-small-cell lung cancer.