In Darwinian evolution, organisms that are well-adapted to their environments flourish and crowd out those that aren’t. My colleagues and I believe that much the same thing happens with cancer in a process we call adaptive oncogenesis.
A key component of this theory is that normal, healthy cells are best adapted to their normal, healthy environments. They have a competitive advantage over cells that develop cancer-causing mutations.
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Anti-cancer therapies that damage healthy tissues, like chemotherapy and radiation therapy, can promote the emergence of more aggressive cancer cells and even new types of cancer.
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Adaptive oncogenesis attributes that in large part to the tissue damage induced by what is supposed to be a beneficial therapy. This creates conditions that favor the selection of cancer cells that are both resistant to the therapy and better adapted to the therapy-damaged environment.
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In the cancer ward, the instinct has long been to eliminate the enemy; success has typically been measured as the destruction of a cancer. But that doesn’t always yield a long-term solution, in good measure due to the failure to properly consider the impact of therapy on the whole body, which can be left heavily damaged. Controlling cancer requires thoughtful manipulation to direct cellular evolutionary trajectories, not brute force.
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