{"entity":{"id":"idea-tr2-sequence-registry","kind":"idea","name":"A registry of every treatment sequence patients actually receive, with outcomes","aka":[],"tldr":"Record, for every patient, the order of treatments and what happened, so that the most common sequences can be compared and the worst ones flagged.","summary":"Approved drugs multiply faster than sequencing trials. A national or multi-centre registry capturing line-by-line therapy and outcomes (as the Flatiron and Dutch cancer registries partly do) with a public dashboard of sequence performance would let clinicians see which sequences are common and which look poor, and give trialists the effect sizes needed to design randomised sequence trials.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Too many combinations to test): Palmer & Sorger, Combination cancer therapy can confer benefit via patient-to-patient variability without drug additivity or synergy (Cell 2017)","url":"https://doi.org/10.1016/j.cell.2017.11.009"}],"tags":[],"related":["idea-tr2-pragmatic-sequence-randomisation"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["real-world-evidence","adc-sequencing"],"trials":[],"people":[],"bottlenecks":["b-combination-space","b-real-world-evidence"],"keyPapers":["paper-palmer-cell"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Publishing sequence-level outcomes will change prescribing away from the bottom-quartile sequences within two years, measurable as a fall in their share of use.","rationale":"Registry feedback changed practice in cardiac surgery and in Dutch colorectal cancer care. The data already exists; it is not assembled by sequence.","test":"Build the dashboard for metastatic breast and colorectal cancer in one health system; publish; measure change in sequence shares.","maturity":"early-clinical","actor":"data","cost":"medium","horizonYears":3},"route":"/ideas/idea-tr2-sequence-registry/","neighbours":{"idea":[{"id":"idea-tr2-pragmatic-sequence-randomisation","kind":"idea","name":"Registry-embedded randomisation of treatment order in routine care","route":"/ideas/idea-tr2-pragmatic-sequence-randomisation/"}],"term":[{"id":"adc-sequencing","kind":"term","name":"ADC sequencing","route":"/terms/adc-sequencing/"},{"id":"real-world-evidence","kind":"term","name":"Real-world evidence","route":"/terms/real-world-evidence/"}],"bottleneck":[{"id":"b-combination-space","kind":"bottleneck","name":"Too many combinations to test","route":"/bottlenecks/b-combination-space/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}],"paper":[{"id":"paper-palmer-cell","kind":"paper","name":"Combination Cancer Therapy Can Confer Benefit via Patient-to-Patient Variability without Drug Additivity or Synergy","route":"/key-papers/paper-palmer-cell/"}]}}