OnCo
ideasIdea

Digital twins for treatment selection, validated by predicting before observing

Build a computer model of each patient's cancer that forecasts how it will respond to each treatment option, and prove it by writing the forecast down before the real result is known.

Patient digital twins (mechanistic, statistical or hybrid models of a patient's tumour and physiology) are proposed for treatment selection, but validation is almost entirely retrospective. The proposal is a validation programme with a strict protocol: for each enrolled patient, the twin's prediction (response, progression time, toxicity) for the chosen treatment is locked before treatment; predictions are compared with observed outcomes; calibration and discrimination are published. Only twins that pass proceed to trials where predictions inform choices.

Hypothesis
Prospectively locked twin predictions will achieve clinically useful calibration for at least one common decision (for example, response to first-line chemo-immunotherapy in NSCLC), and a randomised trial of twin-informed selection will improve response rates.
Rationale
Weather and engineering models earned trust through routine, scored forward prediction; medical models have skipped this step and are trusted or dismissed on retrospective fits.
What would test it
Enrol 500 patients across two cancers; lock predictions; publish calibration plots and Brier scores; proceed to a randomised trial only if pre-specified thresholds are met.
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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