Figure 1

Illustration of the cancer to chronic disease (C2c) approach. (a) C2c core technologies: liquid biopsies (LB) and whole-body imaging (IM). For LB, current assays include circulating tumor cells and circulating tumor DNA as well as microRNAs. Examples of other biomarkers are prostate-specific antigen as exemplar protein biomarker, and 2-hydroxyglutarate as exemplar epigenetic oncometabolite, which is a potent inhibitor of TET demethylases. For IM, current platforms include, for example, magnetic resonance imaging, positron emission tomography and sodium iodide symporter imaging. Images: circulatory system image obtained from Wikimedia Commons (LadyofHats); magnetic resonance image of prostate cancer metastases obtained from Wikimedia Commons (Radswiki); whole body scanner image obtained with permission from Hitachi Medical Systems. (b) Example of longitudinally measured LB and IM signals in response to treatment. The color code in the LB track represents the evolving omic heterogeneity of the cancer, which in turn informs the next best treatment(s). The dotted line denotes the threshold between cancer and chronic disease. The aim is to keep both the LB and IM signals within the range defined as chronic disease.