# Treat resistance like an infectious disease and run national surveillance

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

## TL;DR

Countries track how bacteria become resistant to antibiotics and publish it. Doing the same for cancer drugs would show which escape routes are becoming common and where.

## Summary

Routine post-progression sequencing already happens in health systems that offer routine tumour sequencing, but the results are not aggregated. A surveillance system, modelled on antimicrobial resistance reporting, would pool de-identified mechanism data by drug, line and region, publish periodic reports, and flag emerging mechanisms early. Laboratories would submit structured results as a condition of accreditation or reimbursement.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: National surveillance detects shifts in resistance mechanism frequency (for example rising rates of a specific bypass after a new drug's uptake) at least a year earlier than the published literature.
- Rationale: Antimicrobial resistance surveillance changed prescribing behaviour and guided development priorities; oncology generates the same data but discards its population-level signal.
- Proposed test: Pilot in one country aggregating results from accredited laboratories for two drug classes for 18 months, and compare detection timing of known mechanism trends with publication dates.
- Maturity: speculative
- Actor: policy

## 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: [Drug resistance (primary and acquired)](https://onco.cc/terms/resistance/), [Real-world evidence](https://onco.cc/terms/real-world-evidence/)
- bottlenecks: [Acquired resistance to every therapy](https://onco.cc/bottlenecks/b-resistance/), [Data silos](https://onco.cc/bottlenecks/b-data-silos/), [Weak real-world evidence and registries](https://onco.cc/bottlenecks/b-real-world-evidence/)

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