Ecological and evolutionary dynamics to design and improve ovarian cancer treatment

Author:

Han Grace Y. Q.1ORCID,Alexander Monica2ORCID,Gattozzi Julia3,Day Marilyn4,Kirsch Elayna4,Tafreshi Narges5,Chalar Raafat6,Rahni Soraya7,Gossner Gabrielle8,Burke William8,Damaghi Mehdi6910

Affiliation:

1. Renaissance School of Medicine at Stony Brook University Stony Brook New York USA

2. Department of Molecular and Cellular Biology Stony Brook University Stony Brook New York USA

3. Department of Molecular and Cellular Pharmacology Stony Brook University Stony Brook New York USA

4. Department of Obstetrics and Gynecology Renaissance School of Medicine at Stony Brook University Stony Brook New York USA

5. Cellinfinity Bio New Haven Connecticut USA

6. Stony Brook Cancer Center Renaissance School of Medicine at Stony Brook University Stony Brook New York USA

7. Stony Brook University Stony Brook New York USA

8. Department of Obstetrics and Gynecology Stony Brook University Hospital Stony Brook New York USA

9. Department of Pathology Renaissance School of Medicine at Stony Brook University Stony Brook New York USA

10. Department of Radiation Oncology Renaissance School of Medicine at Stony Brook University Stony Brook New York USA

Abstract

AbstractOvarian cancer ecosystems are exceedingly complex, consisting of a high heterogeneity of cancer cells. Development of drugs such as poly ADP‐ribose polymerase (PARP) inhibitors, targeted therapies and immunotherapies offer more options for sequential or combined treatments. Nevertheless, mortality in metastatic ovarian cancer patients remains high because cancer cells consistently develop resistance to single and combination therapies, urging a need for treatment designs that target the evolvability of cancer cells. The evolutionary dynamics that lead to resistance emerge from the complex tumour microenvironment, the heterogeneous populations, and the individual cancer cell's plasticity. We propose that successful management of ovarian cancer requires consideration of the ecological and evolutionary dynamics of the disease. Here, we review current options and challenges in ovarian cancer treatment and discuss principles of tumour evolution. We conclude by proposing evolutionarily designed strategies for ovarian cancer, with the goal of integrating such principles with longitudinal, quantitative data to improve the treatment design and management of drug resistance.Key points/Highlights Tumours are ecosystems in which cancer and non‐cancer cells interact and evolve in complex and dynamic ways. Conventional therapies for ovarian cancer inevitably lead to the development of resistance because they fail to consider tumours’ heterogeneity and cellular plasticity. Eco‐evolutionarily designed therapies should consider cancer cell plasticity and patient‐specific characteristics to improve clinical outcome and prevent relapse.

Funder

National Institutes of Health

National Cancer Institute

Publisher

Wiley

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