As anyone reading this blog will know, the reason many of us believe cancer is such an incredibly difficult disease to treat is that it evolves in the Darwinian sense of the word. This evolution is fueled by intra-tumour heterogeneity so understanding how it originates and changes over time is an important question. There is no question that patients are different and that two prostate cancer patients will have different prognoses and require different treatments. What is less well understood is that even within a given tumour you will find different tumour cells with different properties, different strengths and requiring different treatments. In this review, Alexander Gelfand describes the work that some groups, an including ours, have been doing in the last few years to understand and address intra-tumour heterogeneity. Certainly worth a read. It describes work from Habil Zare and colleagues to infer tumour heterogeneity in breast cancer. It also describes interesting computational work by Tzamali and colleagues exploring the link between microenvironment and heterogeneity (although I would also cite Sandy Anderson's previous work in Cell in this regard).
Finally there's work from Polyak on how treatments impact tumour heterogeneity and work from our group (including Dr. Jill Gallaher at Sandy Anderson's lab) on how to deal with that heterogeneity in prostate cancer patients with bone metastases. Happy reading!
If you like to know what the image accompanying this post is about: it comes from our Clinical and Experimental metastasis paper and describes how different types of heterogeneity could lead to different results when treated.