# Evolutionary tumour boards with a modeller in the room

Source: https://onco.cc/ideas/idea-bio1-evolutionary-tumour-boards/  
OnCo record `idea-bio1-evolutionary-tumour-boards` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer is an evolving population, but treatment decisions are rarely made with an evolutionary biologist present. Add one to the weekly meeting and see whether decisions change.

## Summary

Molecular tumour boards translate mutations into drugs; none formally consider clonal structure, evolvability, or the expected resistance trajectory. Moffitt has piloted an evolutionary tumour board. The proposal is to fund such boards at ten centres with a common case template (clone structure, growth kinetics, predicted escape routes, proposed schedule) and to audit whether recommendations and outcomes differ from standard boards.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Evolutionary tumour board review changes the recommended sequence or schedule in at least a quarter of advanced-cancer cases and is associated with longer time to second progression in the cases where the recommendation is followed.
- Rationale: Every other field that manages evolving populations, from infectious disease to pest control, uses explicit evolutionary reasoning; oncology has the data (serial ctDNA, imaging) but not the forum.
- Proposed test: Prospective parallel review of 300 cases by standard and evolutionary boards; measure recommendation concordance, and follow outcomes where the evolutionary recommendation was adopted.
- Maturity: speculative
- Actor: clinic

## Sources

- Bottleneck evidence (Tumour heterogeneity and clonal evolution): Gerlinger et al., Intratumor heterogeneity and branched evolution (NEJM 2012): https://doi.org/10.1056/NEJMoa1113205

## Connected records

- institutions: [Moffitt Cancer Center](https://onco.cc/institutions/moffitt/)
- bottlenecks: [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)

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