ideasIdea
A survivor biobank to find who will develop late effects before they do
Two people can have identical treatment and only one develops heart failure or a second cancer years later. Collecting blood and genetic data from survivors could reveal who is at risk and who can be reassured.
Genetic variants (for instance in anthracycline cardiotoxicity), clonal haematopoiesis, and circulating biomarkers may predict late effects, but studies are small and scattered. A prospective survivor biobank with baseline and serial samples linked to treatment exposures and long-term outcomes would allow discovery and validation of predictive markers, enabling risk-adapted surveillance and preventive therapy.
Hypothesis
Within six years the biobank will validate at least one biomarker or polygenic score that stratifies late cardiotoxicity or second-cancer risk with sufficient discrimination to change surveillance intensity.
Rationale
Pharmacogenomic predictors of toxicity have been found where cohorts were large enough; late effects have never had such a resource.
What would test it
Enrol 20,000 survivors with samples at end of treatment and five years, linked to registry outcomes, with pre-registered discovery and validation analyses.
Maturity
speculative
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
6
Bottlenecks it attacks
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Biomarkers are not validated or standardised · Tests that decide who gets a drug are often not validated prospectively and are measured differently in every lab.