Cancer treatment is often aimed at achieving rapid, large, and sustained reductions in tumor burden. Even when these strong responses are achieved, treatment frequently fails due to the emergence of drug‐resistant cell lineages. Over the last decade, a variety of authors have suggested that treatment should instead be aimed at containing resistance rather than curing the patient. That new philosophy poses a dilemma: how to choose between treatment regimens that can sometimes cure the patient and regimens that can delay progression but not cure the patient? Here, we investigate that choice. We define aspects of the evolution and ecology of tumor dynamics that determine whether it is better to attempt cure or to manage resistance. Even when it is possible to manage resistance and delay progression, this may not be the best treatment option. We show that the best option depends on how “cure” and “delaying progression” are prioritized, and how those priorities will vary among patients. We also discuss the difficulties of comparing in clinical trials traditional strategies that can sometimes successfully cure to alternative approaches where cure is not possible. More generally, where resistance management is possible, there are new challenges in communicating options to patients, setting treatment guidelines, and evaluating data from clinical trials.

中文翻译：

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癌症治疗：尝试治愈或控制耐药性？

癌症治疗通常旨在实现肿瘤负荷的快速，大而持续的减轻。即使达到了这些强烈的反应，由于耐药细胞谱系的出现，治疗也经常失败。在过去的十年中，许多作者建议治疗应改为控制抵抗力而不是治愈患者。新的哲学带来了一个难题：如何在有时可以治愈患者的治疗方案和可以延缓病情但不能治愈患者的治疗方案之间进行选择？在这里，我们调查该选择。我们定义了肿瘤动力学的演变和生态学方面，这些方面决定了尝试治愈还是控制耐药性更好。即使可以控制抵抗力并延缓病情发展，这也不是最佳的治疗选择。我们表明，最佳选择取决于如何对“治愈”和“延缓进展”进行优先排序，以及这些优先级在患者之间的差异。我们还将讨论在临床试验中比较传统策略的困难，这些策略有时可以成功地治愈无法治愈的替代方法。更广泛地说，在可能进行耐药性管理的地方，与患者沟通选择方案，制定治疗指南以及评估临床试验数据都面临着新的挑战。