# A fast route to the matched drug when it is licensed for another cancer

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

## TL;DR

Sometimes a progression biopsy shows exactly which drug would help, but it is licensed for another cancer and cannot be obtained. A standing pathway would fix that.

## Summary

Mechanism-matched treatment recommendations frequently fail at the access step. A national pathway modelled on the Dutch DRUP and UK-style access schemes would combine a molecular tumour board decision, company-supplied drug, mandatory outcome registration and payer participation, so that every off-label use generates evidence. This converts scattered compassionate use into a structured cohort study.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A standing mechanism-matched access pathway raises the proportion of actionable resistance findings that result in treatment from a small minority to over half, and generates interpretable efficacy data per mechanism-drug pair.
- Rationale: DRUP-type studies have shown that structured off-label access with outcome collection is feasible and produces usable evidence for rare biomarker-drug combinations.
- Proposed test: Launch a pathway in one country covering ten drugs for three years; measure treatment rate for actionable findings, response rates by cohort, and time from report to first dose.
- Maturity: speculative
- Actor: regulator

## Sources

- DRUP trial (NCT02925234): https://clinicaltrials.gov/study/NCT02925234

## Connected records

- institutions: [Netherlands Cancer Institute (NKI-AvL)](https://onco.cc/institutions/nki/)
- terms: [Real-world evidence](https://onco.cc/terms/real-world-evidence/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/)
- bottlenecks: [Acquired resistance to every therapy](https://onco.cc/bottlenecks/b-resistance/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/), [Regulatory divergence between regions](https://onco.cc/bottlenecks/b-regulatory-fragmentation/)

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