Perspective: plasticity, the enemy of the good

Area of Science:

• Oncology
• Cancer Research
• Translational Medicine

Background:

• Cancer research traditionally focuses on internal cellular mechanisms driving carcinogenesis.
• Therapeutic successes have been limited by the inevitable development of cancer drug resistance.
• The tumor microenvironment adds complexity to understanding cancer etiology, especially in advanced stages.

Purpose of the Study:

• To re-evaluate the level at which cancer plasticity should be considered in research.
• To propose a new perspective on cancer research and care priorities.
• To address the challenges posed by cancer's plastic and multi-site nature.

Main Methods:

• Review of existing models of carcinogenesis.
• Analysis of therapeutic successes and limitations.
• Consideration of the tumor microenvironment's role.
• Conceptual framework development for prioritizing early clinical actions.

Main Results:

• Traditional cell-centered models, while informative, do not fully account for cancer's complexity and resistance.
• The tumor microenvironment significantly impacts cancer etiology, particularly in advanced disease.
• Current approaches face limitations due to cancer's inherent plasticity and resistance.

Conclusions:

• Cancer's plastic and multi-site nature, coupled with the inability to guarantee cures, demands a paradigm shift.
• Early clinical actions should be prioritized in cancer research and care strategies.
• A proactive, early-intervention approach is essential for improving cancer outcomes.