# One open atlas of how tumours escape every drug

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

## TL;DR

Knowledge about how cancers become resistant is scattered across thousands of papers and company files. Pooling it into one structured, public resource would let anyone see the pattern.

## Summary

A curated atlas keyed by drug, target, tumour type and prior therapy, recording observed resistance mechanisms with frequencies, sample sizes and evidence grade, populated from published series, trial correlative data and, ideally, industry-contributed data under a common schema. Analogous resources transformed infectious disease (antimicrobial resistance surveillance) and pharmacogenomics.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A structured atlas covering 50 agents reveals that resistance route frequencies are stable enough across cohorts to support pre-specified, mechanism-anticipating combination designs.
- Rationale: Individual studies are underpowered to estimate mechanism frequency, which is exactly the number a trial designer needs; harmonised pooling is the only route to it.
- Proposed test: Build the atlas for three drug classes with reproducible curation, publish frequency estimates with confidence intervals, and validate them prospectively in an independent progression-biopsy cohort.
- Maturity: preclinical-evidence
- Actor: data

## 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

- companies: [Foundation Medicine (Roche)](https://onco.cc/companies/foundation-medicine/), [Guardant Health](https://onco.cc/companies/guardant-health/)
- terms: [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/), [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/)

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