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2015 ; 75
(22
): 4675-80
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Application of Evolutionary Principles to Cancer Therapy
#MMPMID26527288
Enriquez-Navas PM
; Wojtkowiak JW
; Gatenby RA
Cancer Res
2015[Nov]; 75
(22
): 4675-80
PMID26527288
show ga
The dynamic cancer ecosystem, with its rich temporal and spatial diversity in
environmental conditions and heritable cell phenotypes, is remarkably robust to
therapeutic perturbations. Even when response to therapy is clinically complete,
adaptive tumor strategies almost inevitably emerge and the tumor returns.
Although evolution of resistance remains the proximate cause of death in most
cancer patients, a recent analysis found that evolutionary terms were included in
less than 1% of articles on the cancer treatment outcomes, and this has not
changed in 30 years. Here, we review treatment methods that attempt to understand
and exploit intratumoral evolution to prolong response to therapy. In general, we
find that treating metastatic (i.e., noncurable) cancers using the traditional
strategy aimed at killing the maximum number of tumor cells is evolutionarily
unsound because, by eliminating all treatment-sensitive cells, it enables rapid
proliferation of resistant populations-a well-known evolutionary phenomenon
termed "competitive release." Alternative strategies, such as adaptive therapy,
"ersatzdroges," and double-bind treatments, shift focus from eliminating tumor
cells to evolution-based methods that suppress growth of resistant populations to
maintain long-term control.