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Translational Therapeutics

Intratumour heterogeneity, from hypothesis to the clinic

Summary

Recent technological advances uncovered intricate biological processes underlying intratumor heterogeneity with clinical implications. These insights led to novel biomarkers for immunotherapies, justified serial tumour biopsies for therapeutic target profiling, inspired new treatment strategies, and ultimately might yield novel therapeutics that target clonal interdependence.

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References

  1. Fisher R, Pusztai L, Swanton C. Cancer heterogeneity: implications for targeted therapeutics. Br J Cancer. 2013;108:479–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Jiang T, Shi W, Natowicz R, Ononye SN, Wali VB, Kluger Y, et al. Statistical measures of transcriptional diversity capture genomic heterogeneity of cancer. BMC Genomics. 2014;15:876.

    Article  PubMed  PubMed Central  Google Scholar 

  3. McGranahan N, Swanton C. Clonal heterogeneity and tumor evolution: past, present, and the future. Cell. 2017;168:613–28.

    Article  CAS  PubMed  Google Scholar 

  4. Safonov A, Jiang T, Bianchini G, Győrffy B, Karn T, Hatzis C, et al. Immune gene expression is associated with genomic aberrations in breast cancer. Cancer Res. 2017;77:3317–24.

    Article  CAS  PubMed  Google Scholar 

  5. Marusyk A, Janiszewska M, Polyak K. Intratumor heterogeneity: the rosetta stone of therapy resistance. Cancer Cell. 2020;37:471–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Vitale I, Shema E, Loi S, Galluzzi L. Intratumoral heterogeneity in cancer progression and response to immunotherapy. Nat Med. 2021;27:212–24.

    Article  CAS  PubMed  Google Scholar 

  7. Beerenwinkel N, Schwarz RF, Gerstung M, Markowetz F. Cancer evolution: mathematical models and computational inference. Syst Biol. 2015;64:e1–e25.

    Article  CAS  PubMed  Google Scholar 

  8. Birkbak NJ, McGranahan N. Cancer genome evolutionary trajectories in metastasis. Cancer Cell. 2020;37:8–19.

    Article  CAS  PubMed  Google Scholar 

  9. Shi H, Hugo W, Kong X, Hong A, Koya RC, Moriceau G, et al. Acquired resistance and clonal evolution in melanoma during BRAF inhibitor therapy. Cancer Discov. 2014;4:80–93.

    Article  CAS  PubMed  Google Scholar 

  10. Blakely CM, Watkins TBK, Wu W, Gini B, Chabon JJ, McCoach CE, et al. Evolution and clinical impact of co-occurring genetic alterations in advanced-stage EGFR-mutant lung cancers. Nat Genet. 2017;49:1693–704.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Juric D, Castel P, Griffith M, Griffith OL, Won HH, Ellis H, et al. Convergent loss of PTEN leads to clinical resistance to a PI(3)Kα inhibitor. Nature. 2015;518:240–4.

    Article  CAS  PubMed  Google Scholar 

  12. Brown D, Smeets D, Székely B, Larsimont D, Szász AM, Adnet PY, et al. Phylogenetic analysis of metastatic progression in breast cancer using somatic mutations and copy number aberrations. Nat Commun. 2017;8:14944.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Naffar-Abu Amara S, Kuiken HJ, Selfors LM, Butler T, Leung ML, Leung CT, et al. Transient commensal clonal interactions can drive tumor metastasis. Nat Commun. 2020;11:5799.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Patwardhan GA, Marczyk M, Wali VB, Stern DF, Pusztai L, Hatzis C. Treatment scheduling effects on the evolution of drug resistance in heterogeneous cancer cell populations. NPJ Breast Cancer. 2021;7:60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Reeves MQ, Kandyba E, Harris S, Del Rosario R, Balmain A. Multicolour lineage tracing reveals clonal dynamics of squamous carcinoma evolution from initiation to metastasis. Nat Cell Biol. 2018;20:699–709.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Maddipati R, Stanger BZ. Pancreatic cancer metastases harbor evidence of polyclonality. Cancer Discov. 2015;5:1086–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Marusyk A, Tabassum DP, Altrock PM, Almendro V, Michor F, Polyak K. Non-cell-autonomous driving of tumour growth supports sub-clonal heterogeneity. Nature. 2014;514:54–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Contributing authors for manuscript preparation: NLS, AK and LP. All authors reviewed the manuscript and approved the final version of the manuscript.

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Correspondence to Lajos Pusztai.

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Competing interests

LP has received consulting fees and honoraria from Pfizer, AstraZeneca, Merck, Novartis, Bristol-Myers Squibb, GlaxoSmithKline, Genentech, Personalis, Daiichi, Natera, Exact Sciences and institutional research funding from Seagen, GlaxoSmithKline, AstraZeneca, Merck, Pfizer and Bristol-Myers Squibb.

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Shan, N.L., Kahn, A. & Pusztai, L. Intratumour heterogeneity, from hypothesis to the clinic. Br J Cancer 128, 459–460 (2023). https://doi.org/10.1038/s41416-022-02008-w

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