OnCo
ideasIdea

Re-map the tumour's surface proteins before choosing the next antibody drug

Antibody drugs need their target to still be present. After one fails, checking which surface markers remain would guide the choice of the next one instead of guessing.

Antigen loss and downregulation are documented mechanisms of ADC, bispecific and CAR-T failure. A standardised multiplex panel measuring the main clinical antigens (HER2, TROP2, HER3, CEACAM5, B7-H3, Nectin-4, FOLR1 and others) on a progression biopsy, or by immuno-PET where available, would let clinicians select the next agent by present antigen rather than by tumour type convention.

Hypothesis
Antigen-guided selection of the next antibody-based agent after progression yields a higher response rate than conventional selection, and antigen loss explains a substantial fraction of failures on the prior agent.
Rationale
Antigen expression is dynamic under treatment pressure and archival tissue is a poor guide; the panel technology is routine immunohistochemistry or multiplex imaging, so this is a logistics rather than discovery problem.
What would test it
Prospective cohort of 200 patients progressing on an ADC: run the panel, record whether the recommendation differs from the clinician's plan, and compare outcomes where it was followed.
Maturity
speculative
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks

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