Evolution of phenotypic plasticity leads to tumor heterogeneity with implications for therapy

Author summary Intratumor heterogeneity presents a significant barrier to effective cancer therapy. This heterogeneity stems from the evolution of cancer cells and their capability for phenotypic plasticity. However, the interplay between these two factors still needs to be fully understood. This study examines the interaction between cancer cell evolution and phenotypic plasticity, focusing on the phenotypic switch between migration and proliferation. Such plasticity is particularly relevant to glioblastoma, the most aggressive form of brain tumor. By employing a novel model, we explore how tumor cell evolution, influenced by both genotype and microenvironment, contributes to tumor heterogeneity. We observe that cells at the tumor periphery tend to migrate, while those within the tumor are more inclined to proliferate. Interestingly, our analysis reveals that distinct genetic configurations of the tumor can lead to this observed pattern. Further, we delve into the implications for cancer treatment and discover that it is phenotypic, rather than genetic, heterogeneity that more accurately predicts tumor recurrence following therapy. Our findings offer insights into the significant variability observed in glioblastoma recurrence times post-treatment.