{"entity":{"id":"idea-bio2-vascular-normalisation-window","kind":"idea","name":"Use imaging to find the window when tumour blood vessels are working properly","aka":[],"tldr":"Low doses of anti-blood-vessel drugs briefly make tumour vessels work better, which helps immune cells and other drugs get in. Scans can find that window for each patient.","summary":"Vascular normalisation after low-dose anti-angiogenic therapy is transient and dose-dependent, and DCE-MRI or perfusion CT can measure it patient by patient. Current anti-angiogenic and checkpoint combinations use fixed high doses and fixed schedules, so many patients are likely dosed outside their own normalisation window. Imaging-guided scheduling is a trial design intervention with existing drugs.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Cold tumours and the immunosuppressive microenvironment): Haslam & Prasad, Estimation of the percentage of US patients eligible for and responding to checkpoint inhibitors (JAMA Netw Open 2019)","url":"https://doi.org/10.1001/jamanetworkopen.2019.2535"}],"tags":[],"related":["io-plus-vegf"],"cancers":[],"sections":[],"technologies":["antiangiogenic","mri","checkpoint-inhibitor","pet"],"targets":[],"drugs":["bevacizumab","lenvatinib"],"companies":[],"institutions":[],"pathways":["vegf-angiogenesis"],"terms":[],"trials":[],"people":[],"bottlenecks":["b-tme-immunosuppression","b-dose-optimisation"],"keyPapers":["paper-haslam-jama-netw-open"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Timing checkpoint or cytotoxic administration to an imaging-defined perfusion peak increases intratumoural drug delivery and T-cell infiltration compared with fixed scheduling.","rationale":"Normalisation is well documented in human rectal and glioblastoma studies where perfusion improvement correlated with outcome. Scheduling is free, and imaging endpoints read out in days rather than months.","test":"A randomised imaging-guided versus fixed-schedule window trial with intratumoural drug concentration or CD8 density as the primary endpoint in an accessible tumour.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":5},"route":"/ideas/idea-bio2-vascular-normalisation-window/","neighbours":{"pairing":[{"id":"io-plus-vegf","kind":"pairing","name":"PD-1 blockade + VEGF inhibition","route":"/pairings/io-plus-vegf/"}],"technology":[{"id":"antiangiogenic","kind":"technology","name":"Anti-angiogenic therapy","route":"/technologies/antiangiogenic/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"pet","kind":"technology","name":"PET (positron emission tomography)","route":"/technologies/pet/"}],"drug":[{"id":"bevacizumab","kind":"drug","name":"Bevacizumab","route":"/drugs/bevacizumab/"},{"id":"lenvatinib","kind":"drug","name":"Lenvatinib","route":"/drugs/lenvatinib/"}],"pathway":[{"id":"vegf-angiogenesis","kind":"pathway","name":"VEGF angiogenesis","route":"/pathways/vegf-angiogenesis/"}],"bottleneck":[{"id":"b-tme-immunosuppression","kind":"bottleneck","name":"Cold tumours and the immunosuppressive microenvironment","route":"/bottlenecks/b-tme-immunosuppression/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"paper":[{"id":"paper-haslam-jama-netw-open","kind":"paper","name":"Estimation of the Percentage of US Patients With Cancer Who Are Eligible for and Respond to Checkpoint Inhibitor Immunotherapy Drugs","route":"/key-papers/paper-haslam-jama-netw-open/"}]}}