From: Translating insights into tumor evolution to clinical practice: promises and challenges
 | Therapy | Monitoring | Early diagnosis and stratification | Prevention |
---|---|---|---|---|
Promises | • Clonal therapy targeting clonal mutations to eradicate all tumor cells (such as targeted therapy or immunotherapy) • Preempt resistance • Adaptive therapy to chronically control disease | • Bespoke monitoring based on tumor-specific mutations | • Identify genetic changes meriting intervention | • Mutational signatures can suggest etiological factors that drive early tumorigenesis |
Challenges | • Sampling strategy • Inevitable clonal monotherapy resistance • Bespoke combination therapies complicate toxicity and licensing | • High cost • Novel mutations or subclones may be missed • Early detection of relapse may not improve outcome | • Normal tissues contain canonical cancer mutations • Early diagnosis may not improve outcome | • Exogenous factors may not be preventable • Some tumors may not be preventable (such as those of children or young adults) |