OpenOnco
Project news
Release notes, knowledge-base milestones and governance decisions. Every post is open for comment.
News
25 postsWhy TMB ≥10 mutations/Mb is not a universal biological line
The FDA’s tumour-agnostic TMB-high indication for pembrolizumab used a particular assay and counting rule. The same numeric threshold cannot simply be copied to every sequencing panel or every tumour type.
How a “common essential” gene can still hide a selective weakness
MTAP deletion can make cancer cells more sensitive to PRMT5 inhibition, even though PRMT5 is broadly essential to proliferating cells. The story is a lesson in how the kind of genetic screen used can conceal a biomarker signal.
The same cancer cell line can become different experiments
Laboratory versions of the widely used MCF7 breast-cancer cell line differed genetically and in drug response. The finding is a reminder that a cell-line name is not a complete experimental description.
DRUP: a basket trial does not make all biomarkers equally strong
Cohorts in the Dutch DRUP programme produced sharply different outcomes. The contrast is not evidence that actionability tiers do not matter; its own later analysis argues that strong biological and prior clinical evidence tracked with the better-performing targets.
Precision oncology: what the famous reality checks actually found
SHIVA and NCI-MATCH did not show that all biomarker-matched therapy fails. They showed how steep the route from sequencing to treatment can be and how weak-evidence matches in late-line disease often underdeliver.
Statistically significant is not automatically worthwhile
ESMO-MCBS scores the size of benefit in studies that are already statistically positive. Its purpose is to distinguish a small, formal effect from one likely to matter to patients.
What ESMO grades D and E actually say
ESMO’s D and E grades mean evidence against efficacy or evidence of an adverse outcome. They do not mean merely that evidence is missing; that situation belongs to grade C.
Why a guideline can list a regimen before a phase 3 trial reports
In a study of new multiple-myeloma regimens, NCCN listing often preceded reported phase 3 data. That is a description of one guideline history, not evidence that guidelines routinely run ahead of regulators or that all early listings are equally supported.
Who can ask NCCN to change a guideline?
NCCN accepts guideline-change submissions from clinicians, patient advocates, organisations, payers and industry. The process has a common form and a fixed timetable, but it is not a guarantee that every request reaches a vote.
Cancers that pass between animals
A few animal cancers persist as clonal lineages that can move from one host to another. The oldest known example is a dog cancer likely thousands — not eleven thousand — years old. This is not a naturally occurring human cancer.
Can treatment-tolerant cancer cells become temporarily more mutable?
In colorectal-cancer models, a small population of cells that persists during targeted treatment temporarily changed DNA-repair programmes. It is an intriguing mechanism, but its contribution to resistance in patients is still not settled.
When a chromosome breaks apart in one event
Chromothripsis is a well-established pattern of catastrophic chromosome rearrangement. “Genome chaos” is a broader, less standard interpretation of such crises — not a synonym and not a settled survival strategy.
Is cancer returning to a unicellular past?
Some tumours express older evolutionary gene programmes more strongly and multicellular programmes less strongly. That observation is real; the proposed “atavism” explanation remains a contested research hypothesis.
Normal skin is already full of "cancer" mutations
Sequencing physiologically normal eyelid skin found driver mutations — the same ones found in tumours — in roughly a quarter of cells, at about 140 per square centimetre. The skin was working fine. A driver mutation alone does not make cancer.
What NCCN category 2A actually means
2A is widely read as "weak evidence, weak recommendation." It is not. The panel agreement behind 2A is the same as behind category 1 — and 2A is what you get by default when no category is printed at all.
This section is new, and it is open for comment
Release notes and governance decisions now have a home on the site instead of living only in commit messages. Every post takes comments — with a few rules that a cancer-information site genuinely needs.
Decision-tree routing defects fixed, validator hardened
Auditing every treatment algorithm through the engine walker — rather than the loader — surfaced routing defects that were silently dropping selected indications from rendered plans.
Two doors — and why patients get a different one
The homepage now routes clinicians and patients to different places. Patients get help understanding a plan and preparing questions, not treatment recommendations — a line that has to hold for both safety and regulatory reasons.
An AI assistant can now call the engine instead of guessing
OpenOnco ships an MCP server, so an assistant answering an oncology question can route through the rule engine and return cited output rather than improvising a regimen.
Prevention plans, for people who do not have cancer yet
The charter was amended to cover people at elevated risk but without a diagnosis. The engine now produces a Prevention Plan alongside the Treatment Plan, and the first pilots are live on the site.
85% of our decision-tree conditions were unreadable to the engine
An audit of every treatment algorithm found that most branching conditions were written as English prose the engine cannot evaluate — and that 30% of algorithms therefore fell through to their default on every patient.
What landed in the knowledge base, 30 April to 11 May
A digest of one busy fortnight: haematology, thoracic and breast regimen waves, rare-tumour red flags, CIViC actionability backfill, and a batch of routing fixes.
Biomarker actionability moves from OncoKB to CIViC
A licence audit found OncoKB's terms incompatible with running OpenOnco as a free public resource. Biomarker actionability now builds on CIViC, which is CC0.
Why an LLM never picks the treatment
The project started out asking a language model to rank treatments. That approach is now archived, and the rule that replaced it shapes everything else: recommendations come from a versioned knowledge base, not a model.
Practising oncologists reviewed the engine's plans for the first time
The engine produced treatment plans for a real patient, and the oncologists who read them judged them strong. One case does not validate a system — but it is the first signal from outside the project's own scoring.