{"entity":{"id":"idea-bio1-real-world-resistance-surveillance","kind":"idea","name":"Treat resistance like an infectious disease and run national surveillance","aka":[],"tldr":"Countries track how bacteria become resistant to antibiotics and publish it. Doing the same for cancer drugs would show which escape routes are becoming common and where.","summary":"Routine post-progression sequencing already happens in health systems that offer routine tumour sequencing, but the results are not aggregated. A surveillance system, modelled on antimicrobial resistance reporting, would pool de-identified mechanism data by drug, line and region, publish periodic reports, and flag emerging mechanisms early. Laboratories would submit structured results as a condition of accreditation or reimbursement.","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":["real-world-evidence","resistance"],"trials":[],"people":[],"bottlenecks":["b-resistance","b-real-world-evidence","b-data-silos"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"National surveillance detects shifts in resistance mechanism frequency (for example rising rates of a specific bypass after a new drug's uptake) at least a year earlier than the published literature.","rationale":"Antimicrobial resistance surveillance changed prescribing behaviour and guided development priorities; oncology generates the same data but discards its population-level signal.","test":"Pilot in one country aggregating results from accredited laboratories for two drug classes for 18 months, and compare detection timing of known mechanism trends with publication dates.","maturity":"speculative","actor":"policy","cost":"medium","horizonYears":4},"route":"/ideas/idea-bio1-real-world-resistance-surveillance/","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":"resistance","kind":"term","name":"Drug resistance (primary and acquired)","route":"/terms/resistance/"},{"id":"real-world-evidence","kind":"term","name":"Real-world evidence","route":"/terms/real-world-evidence/"}],"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/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}]}}