{"entity":{"id":"idea-bio1-evolutionary-tumour-boards","kind":"idea","name":"Evolutionary tumour boards with a modeller in the room","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Tumour heterogeneity and clonal evolution): Gerlinger et al., Intratumor heterogeneity and branched evolution (NEJM 2012)","url":"https://doi.org/10.1056/NEJMoa1113205"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["moffitt"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-tumor-heterogeneity","b-workforce"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"small","horizonYears":2},"route":"/ideas/idea-bio1-evolutionary-tumour-boards/","neighbours":{"institution":[{"id":"moffitt","kind":"institution","name":"Moffitt Cancer Center","route":"/institutions/moffitt/"}],"bottleneck":[{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-tumor-heterogeneity","kind":"bottleneck","name":"Tumour heterogeneity and clonal evolution","route":"/bottlenecks/b-tumor-heterogeneity/"}]}}