by Alexander Stein
Cancer is not only a static affliction but a dynamic and evolving entity. At its core, cancer is a disease characterized by the uncontrolled growth and spread of abnormal cells, but its evolution is a complex interplay of genetic mutations, environmental influences, and evolutionary selection. Imagine cancer as a rogue explorer, constantly adapting in response to the challenges it faces. Each cancer is a microcosm of evolution, with diverse cell populations competing for survival. Cancer arises from healthy cells that accumulate necessary drivers. Cancer starts growing from a single cell, and it keeps changing with each cell division. Due to these changes, some regions of the cancer will have different geno- and phenotypes to others leading to what is known as intra-tumor heterogeneity (Figure 1).
Figure 1: Increasing intra-tumor heterogeneity in cancer. As the cancer grows and cells divide, mutations are generated leading to an increased number of genetic heterogeneity, i.e. more genotypes.
Advancements in sequencing methods have revolutionized our ability to understand cancer at a molecular level. By identifying specific genes driving tumor growth, we can develop targeted therapies that aim to disrupt the pathways fueling cancer’s progression. However, as we target one pathway, the cancer often finds alternative routes to survival (Figure 2). This adaptability is a hallmark of cancer evolution, leading to the emergence of treatment-resistant clones and posing a significant challenge for clinicians and researchers.
Figure 2: Complex protein network of head and neck cancer. Understanding protein interactions is important to design effective treatments. However, due to its complexity, it remains difficult to identify vulnerable sites in the network.
Source: DOI: 10.1126/science.abf2911
In the ongoing battle against cancer, evolutionary therapies are emerging as a promising frontier in the quest to overcome treatment resistance. Among these approaches, adaptive therapy stands out as a promising strategy. By administering treatment at doses and schedules that maintain a balance between sensitive and resistant cancer cells, adaptive therapy prevents the emergence of treatment-resistant clones and prolongs the effectiveness of treatment over time. As we continue to explore the frontier of cancer evolution and therapeutic innovation, evolutionary therapies hold the potential to improve cancer care, offering new avenues for conquering the disease.
