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Exploiting evolutionary steering to induce collateral drug sensitivity in cancer

Acar, Ahmet
Nichol, Daniel
Fernandez-Mateos, Javier
Cresswell, George D.
Barozzi, Iros
Hong, Sung Pil
Trahearn, Nicholas
Spiteri, Inmaculada
Stubbs, Mark
Burke, Rosemary
Stewart, Adam
Caravagna, Giulio
Werner, Benjamin
Vlachogiannis, Georgios
Maley, Carlo C.
Magnani, Luca
Valeri, Nicola
Banerji, Udai
Sottoriva, Andrea
Drug resistance mediated by clonal evolution is arguably the biggest problem in cancer therapy today. However, evolving resistance to one drug may come at a cost of decreased fecundity or increased sensitivity to another drug. These evolutionary trade-offs can be exploited using 'evolutionary steering' to control the tumour population and delay resistance. However, recapitulating cancer evolutionary dynamics experimentally remains challenging. Here, we present an approach for evolutionary steering based on a combination of single-cell barcoding, large populations of 10(8)-10(9) cells grown without re-plating, longitudinal non-destructive monitoring of cancer clones, and mathematical modelling of tumour evolution. We demonstrate evolutionary steering in a lung cancer model, showing that it shifts the clonal composition of the tumour in our favour, leading to collateral sensitivity and proliferative costs. Genomic profiling revealed some of the mechanisms that drive evolved sensitivity. This approach allows modelling evolutionary steering strategies that can potentially control treatment resistance. Evolutionary steering uses therapies to control tumour evolution by exploiting trade-offs. Here, using a barcoding approach applied to large cell populations, the authors explore evolutionary steering in lung cancer cells treated with EGFR inhibitors.