Journal
CANCER CELL
Volume 27, Issue 1, Pages 15-26Publisher
CELL PRESS
DOI: 10.1016/j.ccell.2014.12.001
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Funding
- Cancer Research UK
- Rosetrees Trust
- EU [259303]
- Prostate Cancer Foundation
- Breast Cancer Research Foundation
- European Research Council
- Cancer Research UK [17786, 19310] Funding Source: researchfish
- Rosetrees Trust [M179] Funding Source: researchfish
- The Francis Crick Institute [10174, 10359, 10169, 10303, 10172, 10170] Funding Source: researchfish
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Precision medicine requires an understanding of cancer genes and mutational processes, as well as an appreciation of the extent to which these are found heterogeneously in cancer cells during tumor evolution. Here, we explore the processes shaping the cancer genome, placing these within the context of tumor evolution and their impact on intratumor heterogeneity and drug development. We review evidence for constraints and contingencies to tumor evolution and highlight the clinical implications of diversity within tumors. We outline the limitations of genome-driven targeted therapies and explore future strategies, including immune and adaptive approaches, to address this therapeutic challenge.
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