Cancer is an evolutionary process. Cancer initiation and progression are caused by somatic mutation and selection of dividing cells. The mathematical theory of evolution can therefore provide quantitative insights into human cancer. I will discuss the role of chromosomal instability (CIN) and the accumulation of drivers and passengers in growing tumors. I will study success and failure of targeted therapy including combination of different drugs and evolution of resistance. A simple conclusion is that combination treatment can succeed, if the cancer requires at least two point mutations to gain resistance. From the perspective of preventing resistance, simultaneous therapy is highly recommended whereas sequential therapy is a recipe for almost certain treatment failure.
Martin A. Nowak is Professor of Biology and Mathematics at Harvard University and Director of the Program for Evolutionary Dynamics. He works on the mathematical description of evolutionary processes, including the evolution of cooperation and human language, as well as the dynamics of virus infections and human cancer. His major scientific contributions and discoveries include: the mechanism of HIV disease progression; the rapid turnover and evolution of drug resistance in HIV infection; quantifying the dynamics of HBV infection; the evolution of virulence under superinfection and coinfection; the role of chromosomal instability in human cancer; quantifying the dynamics of chronic myeloid leukemia; the accumulation of drivers and passengers in cancer progression; the evolution of drug resistance in targeted cancer therapy; the mechanisms for the evolution of genetic redundancy; "generous tit-for-tat" and "win-stay, lose-shift"; the alternating Prisoner's Dilemma; the evolution of cooperation by indirect reciprocity; spatial game dynamics; adaptive dynamics; evolutionary game dynamics in finite populations; evolutionary graph theory; the five mechanisms for the evolution of cooperation; the evolution of eusociality by natural selection; a mathematical approach for studying the evolution of human language; the dynamics of language regularization; culturomics; "winners don't punish"; prelife; and the origin of evolution.