Important Clinical Questions in Cancer Biology

The most important, and overarching question is:

How can we increase survival?

It is not enough to reduce cancer, if our interventions cause more deaths than the cancer would. Thus, the most important outcome is all cause mortality. But, in order to improve all cause mortality, vis a vis cancer, there are many important clincial questions. Those most likely to be informed by understanding somatic evolution are highlighted in bold.

• When should we intervene (risk stratification)?
  • Applies to both pre-cancer and cancer
  • Who is likely to progress to cancer?
  • Who is unlikely to progress and can be reassured and removed from the medical system?
  • Who should get which interventions?
  • Who should we screen (who has dangerous somatic evolution)?
• When to stop or change treatment?
• How can we delay malignancy?
• How can we increase cancer survival?
  • This does not necessarily require killing cancer cells, though that tends to be people's default approach
  • How can we delay the emergence of therapeutic resistance?
    • This can be cast as an optimization problem
    • Identify patients likely to be resistant
    • What modalities should be used for treatment (which are best for somatic evolution and how do we get synergy)?
      • Agents, Immune, Lifestyle, Devices, Radiation, Gene Therapy
      • How can we develop new modalities?
  • What should we target?
  • Who should get which interventions?
  • How can we reduce the toxicity of our interventions?
• How do we get solutions into a clinic?
  • Somatic evolution doesn't have much to say about this.
• How can we reduce the costs and stress of cancer management?
  • Somatic evolution doesn't have much to say about this.