The "war on cancer" began over 40 years ago with the signing of the National Cancer Act of 1971. Currently, complete eradication has proven possible in early stage premetastatic disease with increasingly successful early detection and surgery protocols; however, late stage metastatic disease remains invariably fatal. One of the main causes of treatment failure in metastatic disease is the ability of cancer cells to evolve resistance to currently available therapies. Evolution of resistance to control measures is a universal problem. While it may seem that the mechanisms of resistance employed by cancer cells are impossible to control, we show that many of the resistance mechanisms are mirrored in agricultural pests. In this way, we argue that measures developed in the agricultural industry to slow or prevent pesticide resistance could be adopted in clinical cancer biology to do the same. The agriculture industry recognized the problem of pesticide resistance and responded by developing and enforcing guidelines on resistance management and prevention. These guidelines, known as integrated pest management (IPM), do not encourage eradication of pests but instead strive to maintain pests, even with the presence of resistant strains, at a level that does not cause economic damage to the crops. Integrated pest management inspired management of metastatic cancer could result in the slowing or curtailing of widespread resistance to treatment, reducing overall drug usage, and increasing the survival and quality of life of patients with cancer. Using IPM principles as a foundation and shifting the goal of treatment of metastatic disease to long-term management will require close monitoring of evolving tumor populations, judicious application of currently available therapies, and development of new criteria of success.

中文翻译：

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抗药性并不是终点：害虫管理的经验教训。

“抗癌之战”始于 40 多年前，随着 1971 年《国家癌症法案》的签署而开始。目前，随着早期检测和手术方案的日益成功，早期转移前疾病的完全根除已被证明是可能的。然而，晚期转移性疾病仍然总是致命的。转移性疾病治疗失败的主要原因之一是癌细胞对当前可用疗法产生耐药性的能力。对控制措施的抵制的演变是一个普遍问题。虽然癌细胞所采用的耐药机制似乎无法控制，但我们发现许多耐药机制也反映在农业害虫中。通过这种方式，我们认为，在农业中开发的减缓或防止农药耐药性的措施可以在临床癌症生物学中采用，以达到同样的效果。农业界认识到农药抗性问题，并通过制定和实施抗性管理和预防指南来应对。这些指南被称为害虫综合管理（IPM），并不鼓励消灭害虫，而是努力将害虫维持在不会对农作物造成经济损失的水平，即使存在抗性菌株。害虫综合防治激发了对转移性癌症的管理，可以减缓或减少广泛的治疗耐药性，减少总体药物使用，并提高癌症患者的生存率和生活质量。以IPM原则为基础并将转移性疾病的治疗目标转向长期管理将需要密切监测不断变化的肿瘤群体、明智地应用当前可用的疗法以及制定新的成功标准。