ideasIdea
Evolutionary tumour boards with a modeller in the room
Cancer is an evolving population, but treatment decisions are rarely made with an evolutionary biologist present. Add one to the weekly meeting and see whether decisions change.
Molecular tumour boards translate mutations into drugs; none formally consider clonal structure, evolvability, or the expected resistance trajectory. Moffitt has piloted an evolutionary tumour board. The proposal is to fund such boards at ten centres with a common case template (clone structure, growth kinetics, predicted escape routes, proposed schedule) and to audit whether recommendations and outcomes differ from standard boards.
Hypothesis
Evolutionary tumour board review changes the recommended sequence or schedule in at least a quarter of advanced-cancer cases and is associated with longer time to second progression in the cases where the recommendation is followed.
Rationale
Every other field that manages evolving populations, from infectious disease to pest control, uses explicit evolutionary reasoning; oncology has the data (serial ctDNA, imaging) but not the forum.
What would test it
Prospective parallel review of 300 cases by standard and evolutionary boards; measure recommendation concordance, and follow outcomes where the evolutionary recommendation was adopted.
Maturity
speculative
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Tumour heterogeneity and clonal evolution · A tumour is many tumours. Treatments that kill most cells leave the rest to grow back, changed.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.