My vision is clearly not 20/20, otherwise I would have remembered that in a presentation like the one I gave last week, you are meant to devote part of your talk to what you intend to do, science-wise, in the medium/long term. During the talk I described, once again, my view of cancer as something that cannot be properly undestood in isolation. A small community of cancer researchers, one in which I include myself, thinks that it is better to talk about the ecosystem of cancer [blog post][blog post]. I am interested in understanding how the interacions between the tumour cells (which is a very heterogeneous population of cells), regular non-cancerous cells and the physical microenvironment shapes selection. Here's our usual picture of how a cancer ecosystem can look like. Bone cancer ecosystem:
One of my colleages at Moffitt, Aga Kasprazak, raised the question of how would I use these ideas to help cancer patients. Very valid question and easy to explain. The main problem with all the treatments we got is that, very often, the tumour evolves resistance to them. Treatments become part of the evolutionary process and strongly select for any tumor phenotype that, on its own or via interactions with the microenvironment, could withstand a little bit better than the others its impact. We then need to understand how evolution, and as part of that, how selection plays a role in treatments. An ecological undestanding of cancer will allow us to guide evolution to a tumour that is less lethal, more treatable. That means that treatments could be designed, not with the aim of killing as many tumour cells as possible, but to transform the tumour: to make it less heterogeneous, less invasive. That will not happen tomorrow but for this to be a reality we need to start rethinking the purpose of the treatments we use.