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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)