Journal
NATURE REVIEWS CANCER
Volume 17, Issue 10, Pages 605-619Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/nrc.2017.69
Keywords
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Categories
Funding
- Wellcome Genome Campus Advanced Courses and Scientific Conferences
- US NIH [P01 CA91955, R01 CA149566, R01 CA170595, R01 CA185138, R01 CA140657]
- CDMRP Breast Cancer Research Program Award [BC132057]
- NIH [R01 CA185138, K99CA201606, CA143803, CA163124, CA093900, CA143055, T32 CA093245, U10 CA180857, U01CA151924, U54CA193489]
- NCI [5R21 CA196460, R21CA196460]
- Breast Cancer Research Foundation
- European Research Council [ERC-617457-PHYLOCANCER]
- Spanish Ministry of Economy and Competitiveness [BFU2015-63774-P]
- Education, Culture and University Development Department of the Galician Government
- Royal Society
- Cancer Research UK [FC001169]
- UK Medical Research Council [FC001169]
- Wellcome Trust [FC001169, 105104/Z/14/Z]
- NovoNordisk Foundation [16584]
- Breast Cancer Research Foundation (BCRF)
- European Research Council (THESEUS)
- Marie Curie Network PloidyNet
- Royal Marsden/ICR National Institute of Health Research Biomedical Research Centre
- Primary Children's Hospital (PCH) Pediatric Cancer Research Program - Intermountain Healthcare Foundation
- PCH Foundation
- Chris Rokos Fellowship in Evolution and Cancer
- PCORI [1505-30497, 1503-29572]
- CRUK Grand Challenge grant
- [R35 CA197623]
- [U01 CA195469]
- [U54 CA193461]
- [R01 CA185138-01]
- [W81XWH-14-1-0473]
- MRC [MR/P014712/1] Funding Source: UKRI
- Cancer Research UK [17786, 18377, 20466, 19310, 21808] Funding Source: researchfish
- Medical Research Council [MR/P014712/1] Funding Source: researchfish
- Rosetrees Trust [M179, M445, M231-CD1, M391, M640] Funding Source: researchfish
- The Francis Crick Institute [10467, 10359, 10172, 10174, VEG 108844, A1278, 10169, C60895/A23896, C28575/A25223, 10485, 10170] Funding Source: researchfish
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Neoplasms change over time through a process of cell-level evolution, driven by genetic and epigenetic alterations. However, the ecology of the microenvironment of a neoplastic cell determines which changes provide adaptive benefits. There is widespread recognition of the importance of these evolutionary and ecological processes in cancer, but to date, no system has been proposed for drawing clinically relevant distinctions between how different tumours are evolving. On the basis of a consensus conference of experts in the fields of cancer evolution and cancer ecology, we propose a framework for classifying tumours that is based on four relevant components. These are the diversity of neoplastic cells (intratumoural heterogeneity) and changes over time in that diversity, which make up an evolutionary index (Evo-index), as well as the hazards to neoplastic cell survival and the resources available to neoplastic cells, which make up an ecological index (Eco-index). We review evidence demonstrating the importance of each of these factors and describe multiple methods that can be used to measure them. Development of this classification system holds promise for enabling clinicians to personalize optimal interventions based on the evolvability of the patient's tumour. The Evo- and Eco-indices provide a common lexicon for communicating about how neoplasms change in response to interventions, with potential implications for clinical trials, personalized medicine and basic cancer research.
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