{"entity":{"id":"idea-bio1-mechanism-matched-access","kind":"idea","name":"A fast route to the matched drug when it is licensed for another cancer","aka":[],"tldr":"Sometimes a progression biopsy shows exactly which drug would help, but it is licensed for another cancer and cannot be obtained. A standing pathway would fix that.","summary":"Mechanism-matched treatment recommendations frequently fail at the access step. A national pathway modelled on the Dutch DRUP and UK-style access schemes would combine a molecular tumour board decision, company-supplied drug, mandatory outcome registration and payer participation, so that every off-label use generates evidence. This converts scattered compassionate use into a structured cohort study.","asOf":"2026-09-08","links":[{"label":"DRUP trial (NCT02925234)","url":"https://clinicaltrials.gov/study/NCT02925234"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["nki"],"pathways":[],"terms":["tumour-agnostic","real-world-evidence"],"trials":[],"people":[],"bottlenecks":["b-resistance","b-generic-repurposing","b-regulatory-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A standing mechanism-matched access pathway raises the proportion of actionable resistance findings that result in treatment from a small minority to over half, and generates interpretable efficacy data per mechanism-drug pair.","rationale":"DRUP-type studies have shown that structured off-label access with outcome collection is feasible and produces usable evidence for rare biomarker-drug combinations.","test":"Launch a pathway in one country covering ten drugs for three years; measure treatment rate for actionable findings, response rates by cohort, and time from report to first dose.","maturity":"speculative","actor":"regulator","cost":"medium","horizonYears":4},"route":"/ideas/idea-bio1-mechanism-matched-access/","neighbours":{"institution":[{"id":"nki","kind":"institution","name":"Netherlands Cancer Institute (NKI-AvL)","route":"/institutions/nki/"}],"term":[{"id":"real-world-evidence","kind":"term","name":"Real-world evidence","route":"/terms/real-world-evidence/"},{"id":"tumour-agnostic","kind":"term","name":"Tumour-agnostic (tissue-agnostic) approval","route":"/terms/tumour-agnostic/"}],"bottleneck":[{"id":"b-resistance","kind":"bottleneck","name":"Acquired resistance to every therapy","route":"/bottlenecks/b-resistance/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-regulatory-fragmentation","kind":"bottleneck","name":"Regulatory divergence between regions","route":"/bottlenecks/b-regulatory-fragmentation/"}]}}