Switch drugs at maximum response, not at relapse
Species go extinct when a second disaster hits a population already shrunk by a first one. Apply the same logic: hit the tumour with a different kind of drug when it is smallest, rather than waiting for it to grow back.
The first-strike, second-strike model from extinction biology proposes that a therapy switch at nadir, when the residual population is small and less diverse, exploits stochastic extinction and pre-empts the expansion of resistant clones. Current practice continues the first drug until progression, when the population is large and resistant. A trial would randomise patients at best response to a mechanistically distinct second strike versus continuation.
- Tumour heterogeneity and clonal evolution · A tumour is many tumours. Treatments that kill most cells leave the rest to grow back, changed.
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
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not linked directly; found by shared links- IdeaEvolutionary tumour boards with a modeller in the room
Shares Moffitt Cancer Center, Tumour heterogeneity and clonal evolution.
- IdeaPause a failed drug so the tumour becomes sensitive to it again
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Melanoma, Non-small-cell lung cancer.
- IdeaEvolution-guided 'adaptive therapy' dosing tested in randomised phase 2 trials
Shares Moffitt Cancer Center, Acquired resistance to every therapy, Melanoma.
- PersonShari Pilon-Thomas
Shares Moffitt Cancer Center, Melanoma.
- IdeaBiopsy the one lesion that is growing while the others shrink
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Melanoma, Non-small-cell lung cancer.
- IdeaSlow the tumour's mutation engine with APOBEC inhibitors during targeted therapy
Shares Tumour heterogeneity and clonal evolution, Acquired resistance to every therapy, Non-small-cell lung cancer.
- PersonEric B. Haura
- IdeaA multi-cancer platform trial of adaptive (dose-holiday) therapy
Shares Moffitt Cancer Center, Tumour heterogeneity and clonal evolution, Melanoma.