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Table 1 Promises and challenges in translating insights into tumor evolution to clinical practice

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)