Journal
NATURE REVIEWS CANCER
Volume 22, Issue 6, Pages 323-339Publisher
NATURE PORTFOLIO
DOI: 10.1038/s41568-022-00454-5
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Funding
- US National Institutes of Health [P50 CA240243, U01 CA253472, R00 CA222554]
- Breast Cancer Research Foundation
- Elsa Pardee Foundation
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Normal and cancer cells utilize adaptive responses to survive environmental stresses, and this Review discusses how tumor ecosystems adapt to therapeutic stresses and how these adaptations can be exploited to overcome cancer therapy resistance.
Normal cells explore multiple states to survive stresses encountered during development and self-renewal as well as environmental stresses such as starvation, DNA damage, toxins or infection. Cancer cells co-opt normal stress mitigation pathways to survive stresses that accompany tumour initiation, progression, metastasis and immune evasion. Cancer therapies accentuate cancer cell stresses and invoke rapid non-genomic stress mitigation processes that maintain cell viability and thus represent key targetable resistance mechanisms. In this Review, we describe mechanisms by which tumour ecosystems, including cancer cells, immune cells and stroma, adapt to therapeutic stresses and describe three different approaches to exploit stress mitigation processes: (1) interdict stress mitigation to induce cell death; (2) increase stress to induce cellular catastrophe; and (3) exploit emergent vulnerabilities in cancer cells and cells of the tumour microenvironment. We review challenges associated with tumour heterogeneity, prioritizing actionable adaptive responses for optimal therapeutic outcomes, and development of an integrative framework to identify and target vulnerabilities that arise from adaptive responses and engagement of stress mitigation pathways. Finally, we discuss the need to monitor adaptive responses across multiple scales and translation of combination therapies designed to take advantage of adaptive responses and stress mitigation pathways to the clinic. This Review discusses mechanisms by which tumour ecosystems adapt to therapeutic stresses and how these could be exploited, as well as challenges associated with tumour heterogeneity. It provides an integrative framework to identify and target vulnerabilities that arise from adaptive responses to overcome cancer therapy resistance.
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