{"entity":{"id":"idea-bio1-mandatory-progression-biopsy","kind":"idea","name":"Fund a biopsy at progression, every time, as standard care","aka":[],"tldr":"When a treatment stops working, the tumour is rarely re-sampled, so nobody learns why. Paying for a biopsy at that moment would build the missing map of resistance.","summary":"Resistance mechanisms are known for only a minority of progressions because the sample is never taken: reimbursement is unclear, the patient is unwell, and there is no trial slot. A funded pathway would pay for a paired tissue and plasma sample at every progression on a targeted agent, with rapid sequencing, a mechanism-matched treatment recommendation returned to the clinician, and deposition into a shared database.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Acquired resistance to every therapy): Soria et al., Osimertinib in untreated EGFR-mutated NSCLC (FLAURA, NEJM 2018)","url":"https://doi.org/10.1056/NEJMoa1713137"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":["cgp","liquid-biopsy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["resistance","ctdna"],"trials":[],"people":[],"bottlenecks":["b-resistance","b-data-silos"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A funded resistance-biopsy pathway raises the proportion of progressions with a defined mechanism from a small minority to over half, and identifies an actionable alteration in a fifth of cases.","rationale":"Where such programmes exist in research settings, mechanism yield is high and actionable findings are common; the barrier is reimbursement and logistics rather than science.","test":"Coverage-with-evidence pilot in one health system for 1,000 progressions: measure mechanism yield, actionability, uptake of matched therapy and cost per actionable finding.","maturity":"early-clinical","actor":"payer","cost":"medium","horizonYears":3},"route":"/ideas/idea-bio1-mandatory-progression-biopsy/","neighbours":{"technology":[{"id":"cgp","kind":"technology","name":"Comprehensive genomic profiling","route":"/technologies/cgp/"},{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"resistance","kind":"term","name":"Drug resistance (primary and acquired)","route":"/terms/resistance/"}],"bottleneck":[{"id":"b-resistance","kind":"bottleneck","name":"Acquired resistance to every therapy","route":"/bottlenecks/b-resistance/"},{"id":"b-data-silos","kind":"bottleneck","name":"Data silos","route":"/bottlenecks/b-data-silos/"}]}}