# A national rapid research autopsy network for end-stage cancer

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

## TL;DR

When patients who agreed in advance die of cancer, sampling every tumour within hours reveals how the disease evolved and escaped every drug. Few hospitals can do this today.

## Summary

Programmes such as PEACE (UK) and CASCADE (Australia) recruit patients in life for post-mortem multi-site sampling within six hours. The proposal is to fund a standing network with 24-hour on-call pathology, consent embedded in oncology clinics, and a common sample and data model, so that terminal clonal architecture becomes a routine, shareable dataset rather than a rarity.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A network processing 500 rapid autopsies a year yields, within five years, a catalogue of metastatic clonal architectures and resistance mechanisms that identifies at least ten recurrent, druggable terminal dependencies not visible in diagnostic biopsies.
- Rationale: Terminal disease is the disease that kills; it is almost never sequenced. Rapid autopsy cohorts have already revealed polyclonal seeding, metastasis-to-metastasis spread and convergent resistance evolution.
- Proposed test: Fund three regional hubs with a shared protocol for two years; measure consent rate, time-to-sampling, sample quality, and the number of novel resistance mechanisms per 100 cases versus the published rate from progression biopsies.
- Maturity: early-clinical
- Actor: philanthropy

## Sources

- PEACE study (NCT03004755): https://clinicaltrials.gov/study/NCT03004755

## Connected records

- technologies: [Single-cell & spatial profiling](https://onco.cc/technologies/single-cell-spatial/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/), [Peter MacCallum Cancer Centre](https://onco.cc/institutions/peter-mac/), [The Francis Crick Institute](https://onco.cc/institutions/francis-crick/)
- bottlenecks: [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)

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