OnCo
ideasIdea

A national rapid research autopsy network for end-stage cancer

When patients who agreed in advance die of cancer, sampling every tumour within hours reveals how the disease evolved and escaped every drug. Few hospitals can do this today.

Programmes such as PEACE (UK) and CASCADE (Australia) recruit patients in life for post-mortem multi-site sampling within six hours. The proposal is to fund a standing network with 24-hour on-call pathology, consent embedded in oncology clinics, and a common sample and data model, so that terminal clonal architecture becomes a routine, shareable dataset rather than a rarity.

Hypothesis
A network processing 500 rapid autopsies a year yields, within five years, a catalogue of metastatic clonal architectures and resistance mechanisms that identifies at least ten recurrent, druggable terminal dependencies not visible in diagnostic biopsies.
Rationale
Terminal disease is the disease that kills; it is almost never sequenced. Rapid autopsy cohorts have already revealed polyclonal seeding, metastasis-to-metastasis spread and convergent resistance evolution.
What would test it
Fund three regional hubs with a shared protocol for two years; measure consent rate, time-to-sampling, sample quality, and the number of novel resistance mechanisms per 100 cases versus the published rate from progression biopsies.
Maturity
early clinical
Who has to act
philanthropy
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks

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