Cancer cells, like crop-devouring pests, can evolve to be resistant to treatments, undermining the effectiveness of therapies and leading to treatment failure. But now, researchers from Arizona State University and colleagues from around the world have posited that adapting pest management principals to cancer treatment approaches could help solve drug resistance and improve survival rates.
This pioneering approach, published in the journal Cancer Research, would redefine cancer treatment from one that attempts to completely eradicate the disease to one that is treated as a chronic condition in instances when curing the disease are unlikely.
“Drug resistance is one of the most important problems we face in clinical oncology,” the researchers wrote. “Solving it will likely require the integration of oncology with evolutionary biology, ecology, bioinformatics, and inspiration from other fields involved in managing systems that evolve therapeutic resistance, including pest management.”
Senior author of the report Carlo Maley, PhD, a professor with the School of Life Sciences at Arizona State, added: “We’ve been treating cancer as if it doesn’t evolve in response to what we do to it. It is time that we take that evolution seriously, guiding it rather than succumbing to it.”
Cancer drug resistance arises when therapies inadvertently select for the survival of resistant cancer cells, much like pesticides select for pesticide-resistant pests. Over time, these populations dominate, making treatment less effective.
Integrated pest management (IPM), a widely used agricultural strategy, combines biological, chemical, and mechanical methods to sustainably control pests. The investigators identified ten principles from IPM that have potential for slowing down cancer as it evolves to elude treatment. Among these are:
- Prevention first: Modifying the environment to create less favorable conditions for cancer cell growth.
- Continuous monitoring: Tracking tumor progression and resistance markers with advanced tools like liquid biopsies.
- Only treat when necessary: Identifying thresholds for when to treat to minimize unnecessary drug use.
- Dose optimization: Using the lowest effective doses to slow evolution of resistance.
- Adaptive treatment: Adjusting doses or rotating therapies to maintain long-term tumor control.
- Non-chemical approaches: Using surgery or immunotherapy to reduce reliance on toxic drugs.
- Forecasting outcomes: Developing predictive models to anticipate tumor behavior to adapt treatment plans.
- Long-term success metrics: Redefining effective treatments to focus on quality of lie and survival as opposed to tumor eradication.
In earlier studies, adaptive therapy—a method inspired by IPM—was tested by the Maley team in preclinical model of drug-resistant breast cancer in mice. Instead of treating the mice with the maximum tolerated doses, the investigators instead used lower, intermittent doses of two cancer drugs. This strategy relied on exploiting competition between drug-sensitive and drug-resistant cancer cells to maintain tumor control and reduced toxicity, showed significantly improved survival times and better outcomes compared to traditional therapies.
According to the study, adaptive therapy represents a paradigm shift in oncology. “If we assume that resistant cells are already present, as pest managers do, this approach represents a fundamental shift from trying to cure cancer to controlling it, with the aim of prolonging patient survival and quality of life,” the researchers wrote.
Although still in its early stages, this approach has the potential to benefit patients with advanced cancers, such as late-stage colorectal cancer, by leveraging its many treatment options. The researchers are planning both clinical trials and preclinical experiments to further test the effectiveness of these principles.
