Mechanisms and clinical implications of tumor heterogeneity and convergence on recurrent phenotypes

Abstract

Tumor heterogeneity has been identified at various -omic levels. The tumor genome, transcriptome, proteome, and phenome can vary widely across cells in patient tumors and are influenced by tumor cell interactions with heterogeneous physical conditions and cellular components of the tumor microenvironment. Here, we explore the concept that while variation exists at multiple -omic levels, changes at each of these levels converge on the same pathways and lead to convergent phenotypes in tumors that can provide common drug targets. These phenotypes include cellular growth and proliferation, sustained oncogenic signaling, and immune avoidance, among others. Tumor heterogeneity complicates treatment of patient cancers as it leads to varied response to therapies. Identification of convergent cellular phenotypes arising in patient cancers and targeted therapies that reverse them has the potential to transform the way clinicians treat these cancers and to improve patient outcome.

Keywords: Cancer therapy; Convergent phenotypes; Tumor heterogeneity; Tumor microenvironment.

Fig. 1

Tumor heterogeneity converges on recurrent cellular phenotypes. a Variations at the genomic, transcriptomic, epigenetic, and proteomic levels influence cellular phenotype b Tumor subclones vary widely in terms of mutational status, epigenetic changes, stochastic transcriptional and translational events, etc. c Changes converge on pathways that output recurrent phenotypes A and B