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About six years ago, Alberto Bardelli fell into a scientific slump. A cancer biologist at the University of Turin in Italy, he had been studying targeted therapies — drugs tailored to the mutations that drive the growth of a tumour. The strategy seemed promising, and some patients started to make dazzling recoveries. But then, inevitably, their tumours became resistant to the drugs. Time and time again, Bardelli would see them relapse. “I stumbled into a wall,” he says. The problem wasn’t the specific mutations, Bardelli realized: it was evolution itself. “Unfortunately, we are facing one of the most powerful forces on this planet,” he says.
Researchers have long understood that tumours evolve. As they grow, mutations arise and populations of genetically distinct cells emerge. The cells that are resistant to treatment survive and expand. No matter what medication physicians apply, it seems, the tumour adapts. And it has been difficult for researchers to unpick this process, because cancer evolves inside the body over the course of years. “We used to say to patients all the time that cancers are evolving in a Darwinian manner, but we didn’t have a huge amount of evidence at our disposal to really formally prove that,” says Charles Swanton, a cancer researcher at the Francis Crick Institute in London.
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