ideasIdea
One open atlas of how tumours escape every drug
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.
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.
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.
What would test it
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
Who has to act
data
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
- Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.
- Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.