The Molecular Aspects of Personalized Anticancer Treatment

Only 25% of cancer patients, on average, benefit from therapy. Even in the cases of complete clinical response the tumor progression is an event of high level expectation. The main reasons for tumor progression are: intratumor heterogeneity resulted from clonal evolution, drug resistance, and tumor-promoting microenvironment. The reprogramming of microenvironmental stromal-inflammatory components is expected to allow tumor phenotype reversion. So, to find the new effective markers of tumor progression, drug response and targets for therapy, it could be promising to take into account the tumor-microenvironment heterogeneity and tumor clonal evolution. TUMOR CLONAL EVOLUTION REQUIRES THE PERSONALIZED THERAPY FOR CANCER PATIENTS The main types of treatment for cancer are: surgical removal of the primary tumor and metastasis, radiotherapy and chemotherapy, including targeted therapy directing to dominant tumor specific molecular aberration. Cancer is known to be a multifactorial pathology developing under the influence of carcinogenic factors, life style, including diet and reproductive behavior, the effects of which are very variable in different individuals due to the unique genetic characteristics for each person. The complexity of tissue ecosystem of cancer cells is endowed by the interrelationship between exposures to environmental agents of chemical, physical and biological nature, the constitutive genetics of the host cells, systemic regulators, local regulators (microenvironment) and architectural constraints, which provide the evolution of somatic cells, tumor biological behavior and finally the disease outcome. Each person is undoubtedly a unique ecosystem that requires the individual (personalized) approaches to the treatment of cancer. The question “Who or what should be treated: the patient or disease?” has the only answer: “The patient should be treated!!!”. This is the basis for the development of personalized medicine. Personalized medicine means the application of patient-specific genetic information (both germline and somatic) and molecular and/or cellular tumor characteristics to select the optimal treatment for individual patient with the goal of improved therapeutic efficacy and reduced toxicity [1]. In accordance with Peter Nowell (“Clonal evolution of tumor cell population”, Science, 1976), the tumor evolutionary trajectories are complex and branching, in parallel with Darwin’s iconic evolutionary speciation tree. Physics of Cancer: Interdisciplinary Problems and Clinical Applications (PC’16) AIP Conf. Proc. 1760, 020010-1–020010-5; doi: 10.1063/1.4960229 Published by AIP Publishing. 978-0-7354-1418-1/$30.00