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A view on drug resistance in cancer

Author

Listed:
  • Neil Vasan

    (Memorial Sloan Kettering Cancer Center
    Weill Cornell Medical College)

  • José Baselga

    (Memorial Sloan Kettering Cancer Center
    Weill Cornell Medical College
    AstraZeneca)

  • David M. Hyman

    (Memorial Sloan Kettering Cancer Center
    Weill Cornell Medical College)

Abstract

The problem of resistance to therapy in cancer is multifaceted. Here we take a reductionist approach to define and separate the key determinants of drug resistance, which include tumour burden and growth kinetics; tumour heterogeneity; physical barriers; the immune system and the microenvironment; undruggable cancer drivers; and the many consequences of applying therapeutic pressures. We propose four general solutions to drug resistance that are based on earlier detection of tumours permitting cancer interception; adaptive monitoring during therapy; the addition of novel drugs and improved pharmacological principles that result in deeper responses; and the identification of cancer cell dependencies by high-throughput synthetic lethality screens, integration of clinico-genomic data and computational modelling. These different approaches could eventually be synthesized for each tumour at any decision point and used to inform the choice of therapy.

Suggested Citation

  • Neil Vasan & José Baselga & David M. Hyman, 2019. "A view on drug resistance in cancer," Nature, Nature, vol. 575(7782), pages 299-309, November.
    • Handle: RePEc:nat:nature:v:575:y:2019:i:7782:d:10.1038_s41586-019-1730-1
    DOI: 10.1038/s41586-019-1730-1
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