Lessons from oncology: Can cancer lead the way in resistance management?

Abstract

The evolution of resistance to chemical interventions is a widespread challenge in medicine and agriculture, affecting bacteria, viruses, parasites, cancer, pests, and weeds. Many resistance management strategies have been proposed, but empirical comparisons are rare, especially in large-scale systems like agriculture and public health, where populations are difficult to replicate, and interventions cannot easily be tested experimentally. Cancer offers a unique opportunity to study resistance evolution. Because evolution occurs within individual patients, resistance strategies can be tested directly in clinical trials, with each patient serving as an independent replicate. Combined with diverse therapies and experimental models, this makes oncology a powerful system for studying therapeutic resistance. Whether insights from cancer apply to other systems remains an open but testable question. Addressing this could reveal general principles of resistance evolution and help unify currently fragmented approaches to resistance management across disciplines.