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Author Notes:

Correspondence: Jack L. Arbiser (jarbise@emory.edu)

J.L.A. authored majority of the manuscript.

M.Y.B. and L.C.G. contributed with manuscript preparation and figures.

We are grateful to Professor Pere Puigserver, Ph.D., of the Department of Cell Biology, Harvard Medical School and the Department of Cancer Biology, Dana-Farber Cancer Institute for his expert insight on cell signaling and mitochondrial biogenesis in melanoma.

We would like to thank Brian C. Brockway, M.S., Medical Media, Atlanta VA Medical Center, for creating the figures used in this publication.

The authors declare that they have no competing financial interests.


Research Funding:

J.L.A. is supported by the RO1 AR47901 and P30 AR42687, and NIH-NCI grant CA163800 (D.P.).

Emory Skin Disease Research Core Center Grant from the National Institutes of Health, a Veterans Administration Hospital Merit Award 1I01BX002926-01A1, as well as funds from the Margolis Foundation, Rabinowitch-Davis Foundation for Melanoma Research, the Betty Minsk Foundation for Melanoma Research, and the Reynolds Family Foundation, USA.

Targeting the duality of cancer.


Journal Title:

npj Precision Oncology


Volume 1


Type of Work:

Article | Final Publisher PDF


Cancer is the second leading cause of death in the United States, and is an increasing cause of death in the developing world. While there is great heterogeneity in the anatomic site and mutations involved in human cancer, there are common features, including immortal growth, angiogenesis, apoptosis evasion, and other features, that are common to most if not all cancers. However, new features of human cancers have been found as a result of clinical use of novel "targeted therapies," angiogenesis inhibitors, and immunotherapies, including checkpoint inhibitors. These findings indicate that cancer is a moving target, which can change signaling and metabolic features based upon the therapies offered. It is well-known that there is significant heterogeneity within a tumor and it is possible that treatment might reduce the heterogeneity as a tumor adapts to therapy and, thus, a tumor might be synchronized, even if there is no major clinical response. Understanding this concept is important, as concurrent and sequential therapies might lead to improved tumor responses and cures. We posit that the repertoire of tumor responses is both predictable and limited, thus giving hope that eventually we can be more effective against solid tumors. Currently, among solid tumors, we observe a response of 1/3 of tumors to immunotherapy, perhaps less to angiogenesis inhibition, a varied response to targeted therapies, with relapse and resistance being the rule, and a large fraction being insensitive to all of these therapies, thus requiring the older therapies of chemotherapy, surgery, and radiation. Tumor phenotypes can be seen as a continuum between binary extremes, which will be discussed further. The biology of cancer is undoubtedly more complex than duality, but thinking of cancer as a duality may help scientists and oncologists discover optimal treatments that can be given either simultaneously or sequentially.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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