Biological and Therapeutic Impact of Intratumor Heterogeneity in Cancer Evolution
Cet article passe en revue les travaux récents sur le rôle de l'hétérogénéité intratumorale dans les mécanismes de résistance aux thérapies ciblées
Precision medicine requires an understanding of cancer genes and mutational processes, as well as an appreciation of the extent to which these are found heterogeneously in cancer cells during tumor evolution. Here, we explore the processes shaping the cancer genome, placing these within the context of tumor evolution and their impact on intratumor heterogeneity and drug development. We review evidence for constraints and contingencies to tumor evolution and highlight the clinical implications of diversity within tumors. We outline the limitations of genome-driven targeted therapies and explore future strategies, including immune and adaptive approaches, to address this therapeutic challenge.