A new mathematical study explores how evolutionary principles could help doctors stay ahead of treatment-resistant cancers.
A new study suggests that improving the timing of cancer treatments could help increase cure rates.
The study’s principal investigator, Dr. Robert Noble, Senior Lecturer at the Department of Mathematics, City, St George’s, University of London, focused on a persistent challenge in cancer treatment.
“Although tumors may at first shrink under therapy,” he explains, “in many cases they eventually regrow. These relapses stem from a small number of cancer cells that have gained mutations, making the cells resistant to the treatment.”
Resistance changes the timing problem
In standard care, doctors often wait to see whether a tumor grows back before moving to another treatment. By then, some cancer cells may already have developed mutations that allow them to resist the second therapy as well, making that treatment less likely to work.
Evolutionary theory points to a different option. Rather than waiting for relapse, doctors may be able to switch to a second treatment while the tumor is still responding to the first. This “kick it while it’s down” strategy is most relevant when clinical experience shows that even the strongest first treatment often stops working because resistant cells emerge.
As Dr. Noble explains in a podcast about the study, “Evolutionary approaches have been very successful in other contexts, such as combating antibiotic resistance, or predicting what vaccines we should use in a particular flu season. There is every reason to suppose that similar approaches should work in tumors.”
Evolutionary models test a new strategy
To examine the idea, Dr. Noble and colleagues adapted mathematical techniques more often used to study how plants and animals evolve under environmental pressures, including climate change.
Based on their analysis, Dr. Noble and colleagues conclude that the strategy should now be tested further in experiments and clinical studies. Three small clinical trials are already underway in soft tissue cancer, prostate cancer, and breast cancer. Additional trials are also being developed.
More treatments may reach larger tumors
“Our models predict that this new approach will generally outperform the standard of care,” explains Dr. Noble. “A sequence of two treatments, even if optimally timed, is likely to succeed only in relatively small tumors. But we have reason to hope that switching between three or more treatments, following the same principle, could eliminate larger tumors.”
Reference: “Preventing evolutionary rescue in cancer using two-strike therapy” by Srishti Patil, Armaan Ahmed, Yannick Viossat and Robert Noble, 26 November 2025, Genetics.
DOI: 10.1093/genetics/iyaf255
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2 Comments
This concept is already in use.
Yes , on me.