Darwinian Strategies to Avoid the Evolution of Drug Resistance During Cancer Treatment

Abstract

A major reason cancer is so difficult to cure is that it changes during treatment, such that drugs that were initially effective soon stop working. After a cancer acquires resistance to the drug that was used to treat it, the patient often relapses and dies. This accounts for many cancer deaths. Acquired drug resistance happens because a cancer is an evolving population of abnormal (mutated) human cells. Evolutionary theory has been used to understand exactly why and how cancers and other disease-causing cells acquire the ability to resist the drugs used against them. Evolutionary theory also suggests ways to prevent the problem with a different kind of therapeutic drugs. ‘Antisocial’ therapies do not selectively kill individual cells that are sensitive to them, but instead disrupt the ability of cancer cells to thrive collectively by providing benefits to each other. The approach has been shown to work on other kinds of disease-causing cells, without driving the evolution of drug resistance. This has not been tested yet for cancer, and it needs to be.