Beckman Robert A, Yeang Chen-Hsiang
Center for Evolution & Cancer, Helen Diller Family Cancer Center, University of California at San Francisco, San Francisco, CA, USA.
Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, Taiwan.
Per Med. 2014 Sep;11(7):705-719. doi: 10.2217/pme.14.57.
Cancer is an evolutionary process that is driven by mutation and selection. Tumors are genetically unstable, and research has shown that this is the most efficient way for cancers to evolve. Genetic instability leads to genetic heterogeneity and dynamic change within a single individual's tumor, in turn leading to therapeutic resistance. Cancer treatment has also evolved from an empirical science of killing dividing cells to the current era of 'personalized medicine', exquisitely targeting the molecular features of individual cancers. However, current personalized medicine regards a single individual's cancer as largely uniform and static. Moreover, from a strategic perspective, current personalized medicine thinks primarily of the immediate therapy selection. Ongoing research suggests that new, nonstandard personalized treatment strategies that plan further ahead and consider intratumoral heterogeneity and the evolving nature of cancer (due to genetic instability) may lead to the next level of therapeutic benefit beyond current personalized medicine.
癌症是一个由突变和选择驱动的进化过程。肿瘤具有基因不稳定性，研究表明这是癌症进化的最有效方式。基因不稳定性导致单个个体肿瘤内的基因异质性和动态变化，进而导致治疗抗性。癌症治疗也已从杀死分裂细胞的经验性科学发展到当前的“个性化医疗”时代，精准靶向个体癌症的分子特征。然而，当前的个性化医疗将单个个体的癌症视为在很大程度上是均匀且静态的。此外，从战略角度来看，当前的个性化医疗主要考虑即时的治疗选择。正在进行的研究表明，新的、非标准的个性化治疗策略，如果能更前瞻性地规划，并考虑肿瘤内异质性以及癌症的进化性质（由于基因不稳定性），可能会带来超越当前个性化医疗的下一级治疗益处。
