ideasIdea
The pathology lab triggers a trial referral the day a rare cancer is diagnosed
The pathologist is the first person to know a cancer is rare or has a targetable marker. A rule in the lab system could notify a trial team at that moment, before treatment decisions close the window.
Laboratory information systems flag defined diagnoses (rare histologies, MSI-high, NTRK fusion, specific paediatric-type tumours in adults) and send a structured notification to a regional trial coordination office and the treating clinician, with matched trials attached. Consent-to-contact rules govern direct patient contact. Precedents exist in stroke and sepsis alerting; oncology pathology alerting has been used for HER2 and MSI testing completeness.
Hypothesis
Pathology-triggered referral will increase the proportion of patients with the flagged diagnoses seen by a trial team before first-line treatment, and enrolment in first-line trials for those diagnoses.
Rationale
For many rare cancers the only trial is first-line; once standard chemotherapy starts, the patient is ineligible. Diagnosis-time alerting acts before the window closes.
What would test it
Implement in one regional pathology network for five diagnoses; compare pre-treatment trial-team contact rate and first-line trial enrolment with neighbouring regions.
Maturity
speculative
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
- Rare and paediatric cancers without markets · Taken together rare cancers are a fifth of all cancers, but each one alone is too small for a company to invest in.