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Fig. 2 | Genome Medicine

Fig. 2

From: Strategies for monitoring and combating resistance to combination kinase inhibitors for cancer therapy

Fig. 2

Heterogeneity and clinical resistance to targeted therapy. Genetic heterogeneity in human tumors can result in multiple outcomes for clinical responses to targeted therapy. In each case, monitoring tumor dynamics by analysis of liquid biopsies may improve clinical interventions. a A targetable genetic alteration (gray) may be present in most tumor cells, but may occur concurrently with resistance-driving mutations. This leads to upfront resistance despite the presence of the targetable alteration. b A targetable genetic alteration may only be present in a minority of tumor cells. In this case, the majority of cells in a particular tumor will exhibit upfront resistance. c Acquired resistance occurs when resistant subclones are selected from a heterogeneous tumor. Geographical resistance occurs when tumors are geographically heterogeneous and exhibit different genetic alterations at different tumor sites. In this case, each tumor will respond differently to targeted therapy

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