Cancer dates back millions of years. Now we are cracking its evolutionary code

Credit: Steve Gschmeissner/Getty Images
Credit: Steve Gschmeissner/Getty Images

Cancer cells are on a continual evolutionary journey of mutation and proliferation, creating a genetically diverse population with a range of selective advantages and disadvantages, depending on the selective pressures at work. Once a cancer has grown to a certain size, somewhere in this heterogeneous population will be cells with mutations rendering them resistant to any treatment that can be thrown at them. Even within a tumor the size of a grain of sugar, the seeds of resistance may already have been sown.

It’s time to think smarter about how we approach cancer treatment, acknowledging the evolutionary power of cancer and using it to our advantage. Adaptive therapies, developed by pioneers such as Robert Gatenby and his colleagues at the Moffitt Cancer Center in Tampa, Florida, aim to steer the trajectory of cancer by balancing populations of drug-resistant and sensitive cells through careful monitoring and dosing. This approach has shown remarkable success in advanced prostate cancer and is now being tested in other tumor types.

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To [actually eradicate cancer], we need to think about extinction strategies: regimens designed to apply specific selective pressures at the right time to cause the population of cancer cells to collapse, just as multiple different factors (shrinking habitat, disease, predation, and so on) drive animal populations to extinction in nature. 

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