# Fund a biopsy at progression, every time, as standard care

Source: https://onco.cc/ideas/idea-bio1-mandatory-progression-biopsy/  
OnCo record `idea-bio1-mandatory-progression-biopsy` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When a treatment stops working, the tumour is rarely re-sampled, so nobody learns why. Paying for a biopsy at that moment would build the missing map of resistance.

## Summary

Resistance mechanisms are known for only a minority of progressions because the sample is never taken: reimbursement is unclear, the patient is unwell, and there is no trial slot. A funded pathway would pay for a paired tissue and plasma sample at every progression on a targeted agent, with rapid sequencing, a mechanism-matched treatment recommendation returned to the clinician, and deposition into a shared database.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A funded resistance-biopsy pathway raises the proportion of progressions with a defined mechanism from a small minority to over half, and identifies an actionable alteration in a fifth of cases.
- Rationale: Where such programmes exist in research settings, mechanism yield is high and actionable findings are common; the barrier is reimbursement and logistics rather than science.
- Proposed test: Coverage-with-evidence pilot in one health system for 1,000 progressions: measure mechanism yield, actionability, uptake of matched therapy and cost per actionable finding.
- Maturity: early-clinical
- Actor: payer

## Sources

- Bottleneck evidence (Acquired resistance to every therapy): Soria et al., Osimertinib in untreated EGFR-mutated NSCLC (FLAURA, NEJM 2018): https://doi.org/10.1056/NEJMoa1713137

## Connected records

- technologies: [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Drug resistance (primary and acquired)](https://onco.cc/terms/resistance/)
- bottlenecks: [Acquired resistance to every therapy](https://onco.cc/bottlenecks/b-resistance/), [Data silos](https://onco.cc/bottlenecks/b-data-silos/)

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