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.
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.
Cost to try
Small (under $1M)
Bottlenecks it attacks
- Tumour heterogeneity and clonal evolution · Every tumour is a population of genetically distinct clones: in multi-region sequencing of kidney tumours, roughly two thirds of mutations were missing from at least one region. Treatment kills the dominant clones and leaves resistant minor clones to grow back, yet a single diagnostic biopsy is still treated as the whole disease.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.