Cancer fix Darwin Evolution

Overview of Cancer Therapy

• In 2019, an estimated 31,000 men in the U.S. diagnosed with metastatic prostate cancer.

• Traditional treatments involve 52 approved drugs, yet over 75% of patients eventually succumb to their illness.

Principles of Evolution in Cancer

Cancer and Evolution

• Metastatic cancer parallels Darwin's natural selection theory:

  • Example: Darwin's Galápagos finches adapt beak shapes to local seeds, similar adaptation occurs in cancer cells.

  • Cancer cells can outcompete normal cells under certain environmental changes (e.g., inflammation, aging).

• Concept of Adaptive Oncogenesis

  • Success of cancer cells is influenced by their surrounding environment rather than just mutations.

  • Evidence supports that altering the tissue environment can influence cancer growth.

Evolutionary Perspective on Cancer Treatment

• Traditional therapy focuses primarily on eliminating cancer cells through high-dose chemotherapy.

• Alternative approach: Adaptive Therapy

  • Maintains a small population of chemosensitive (sensitive to chemotherapy) cells to control tumor growth.

  • In clinical trials, this method has prolonged control of prostate cancer (average of 34 months) using lower doses of chemotherapy.

Understanding the Causes of Cancer

Factors Leading to Cancer

• Common belief attributes cancer to mutations induced by aging, smoking, and radiation.

  • While true, this view neglects the significant role of environmental factors in cancer evolution.

• Environmental changes can promote advantageous mutations leading to cancer progression.

Role of Tissue Environment

• Evolution of species is highly linked to environmental perturbations that dictate adaptive traits.

• Darwin's Postulate: Slight variations advantageous to an individual bolster survival and are thus preserved over generations.

• Similar dynamics observed with cancer cells where mutations may not always confer advantages unless the environment is conducive.

Treatment Strategies

Conventional vs. Adaptive Therapy

• Conventional chemotherapy administers the maximum tolerated dose aiming for complete cell eradication.

• Adaptive Therapy:

  • Uses lower doses to preserve drug-sensitive cells, which can compete with and suppress growth of drug-resistant cells over time.

  • Early trials indicate this strategy can extend tumor control significantly longer while reducing overall drug exposure and side effects.

Evolution and Drug Resistance

Farming Example: Integrating Pest Management

• Pesticide overuse leads to resistant pests, emphasizing the importance of managing populations rather than attempting total eradication.

• The cancer treatment field can learn from pesticide management:

  • Sparing use of chemotherapy could prevent the emergence of drug-resistant cancer cells.

Conclusion

• Understanding cancer through an evolutionary lens provides insight into treatment strategies and prevention.

• Potential to develop prevention strategies that shape tissue environments favoring normal over cancerous cells.

• Emphasizes the importance of continued adaptation of cancer therapy grounded in evolutionary principles.

Lessons from Pest and Antibiotic Resistance for Cancer Treatment

1. Integration of Management Strategies: Just as pesticide overuse leads to resistant pests, overuse of chemotherapy can lead to drug-resistant cancer cells. This highlights the importance of strategically managing cancer treatment rather than pursuing complete eradication of cancer cells.

2. Adaptive Treatment Approaches: Pesticide management utilizes techniques to preserve sensitive populations while controlling resistant ones. Similarly, adaptive therapy for cancer involves using lower doses of chemotherapy to keep chemosensitive cells that can suppress the growth of resistant cells.

3. Population Control over Eradication: The focus should be on managing cancer cell populations, akin to integrated pest management strategies that aim to control pest populations rather than completely eliminate them. This could prevent the emergence of drug-resistant cancer cells, potentially extending treatment effectiveness.

Ethical and Practical Concerns:

• Patient Outcomes: There may be concerns regarding the short-term impact on patients if lower doses are used instead of aggressive treatment.

• Access and Equity: Unequal access to sophisticated treatment strategies could arise, where only certain patients benefit from tailored adaptive therapies.

• Long-term Monitoring: Ensuring adequate follow-up care and assessment would be necessary to monitor potential resistance development in cancer treatment, which may complicate treatment protocols.

• Informed Consent: Patients must be fully informed about the potential risks and benefits of adaptive strategies compared to traditional approaches to make educated decisions about their treatment options.