ideasIdea
A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled
After surgery or curative treatment, everyone gets regular blood tests for leftover cancer DNA, and the pooled results power forecasts of who will relapse and trials of acting early.
Circulating tumour DNA detects molecular residual disease months before imaging, and trials such as DYNAMIC and IMvigor011 show it can guide adjuvant decisions. Uptake is piecemeal and results are not pooled. The proposal is a national programme offering serial MRD testing to all patients treated with curative intent for high-risk cancers, with data flowing to a shared platform that continuously estimates relapse risk, feeds MRD-triggered trial randomisation, and reports test performance by tumour type and assay.
Hypothesis
Universal MRD surveillance with pooled analytics increases the proportion of relapses detected at molecular stage to over 70%, enables MRD-triggered trials that improve cure rates, and reduces unnecessary adjuvant therapy in MRD-negative patients.
Rationale
Early intervention on minimal disease is more likely to cure than treating bulk relapse; assays are validated and the marginal cost of testing is falling. Pooling turns each patient into evidence.
What would test it
Regional programme in colorectal, bladder and breast cancer with embedded randomised MRD-triggered treatment and de-escalation arms; endpoints molecular-stage detection rate and disease-free survival.
Maturity
early clinical
Who has to act
data
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks
- Dormant cells and minimal residual disease · After a 'successful' treatment, cells can sleep for years then relapse. We can barely detect them and cannot target them.
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.