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      Understanding Drug Sensitivity and Tackling Resistance in Cancer

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          Abstract

          Decades of research into the molecular mechanisms of cancer and the development of novel therapeutics have yielded a number of remarkable successes. However, our ability to broadly assign effective, rationally targeted therapies in a personalized manner remains elusive for many patients, and drug resistance persists as a major problem. This is in part due to the well-documented heterogeneity of cancer, including the diversity of tumor cell lineages and cell states, the spectrum of somatic mutations, the complexity of microenvironments, and immune-suppressive features and immune repertoires, which collectively require numerous different therapeutic approaches. Here, we describe a framework to understand the types and biological causes of resistance, providing translational opportunities to tackle drug resistance by rational therapeutic strategies.

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          Comprehensive molecular portraits of human breast tumors

          Summary We analyzed primary breast cancers by genomic DNA copy number arrays, DNA methylation, exome sequencing, mRNA arrays, microRNA sequencing and reverse phase protein arrays. Our ability to integrate information across platforms provided key insights into previously-defined gene expression subtypes and demonstrated the existence of four main breast cancer classes when combining data from five platforms, each of which shows significant molecular heterogeneity. Somatic mutations in only three genes (TP53, PIK3CA and GATA3) occurred at > 10% incidence across all breast cancers; however, there were numerous subtype-associated and novel gene mutations including the enrichment of specific mutations in GATA3, PIK3CA and MAP3K1 with the Luminal A subtype. We identified two novel protein expression-defined subgroups, possibly contributed by stromal/microenvironmental elements, and integrated analyses identified specific signaling pathways dominant in each molecular subtype including a HER2/p-HER2/HER1/p-HER1 signature within the HER2-Enriched expression subtype. Comparison of Basal-like breast tumors with high-grade Serous Ovarian tumors showed many molecular commonalities, suggesting a related etiology and similar therapeutic opportunities. The biologic finding of the four main breast cancer subtypes caused by different subsets of genetic and epigenetic abnormalities raises the hypothesis that much of the clinically observable plasticity and heterogeneity occurs within, and not across, these major biologic subtypes of breast cancer.
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            Microenvironmental regulation of tumor progression and metastasis.

            Cancers develop in complex tissue environments, which they depend on for sustained growth, invasion and metastasis. Unlike tumor cells, stromal cell types within the tumor microenvironment (TME) are genetically stable and thus represent an attractive therapeutic target with reduced risk of resistance and tumor recurrence. However, specifically disrupting the pro-tumorigenic TME is a challenging undertaking, as the TME has diverse capacities to induce both beneficial and adverse consequences for tumorigenesis. Furthermore, many studies have shown that the microenvironment is capable of normalizing tumor cells, suggesting that re-education of stromal cells, rather than targeted ablation per se, may be an effective strategy for treating cancer. Here we discuss the paradoxical roles of the TME during specific stages of cancer progression and metastasis, as well as recent therapeutic attempts to re-educate stromal cells within the TME to have anti-tumorigenic effects.
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              Elements of cancer immunity and the cancer–immune set point

              Immunotherapy is proving to be an effective therapeutic approach in a variety of cancers. But despite the clinical success of antibodies against the immune regulators CTLA4 and PD-L1/PD-1, only a subset of people exhibit durable responses, suggesting that a broader view of cancer immunity is
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                Author and article information

                Contributors
                On behalf of : for the Drug Resistance and Sensitivity Network
                Journal
                Cancer Res
                Cancer Res
                Cancer Research
                American Association for Cancer Research
                0008-5472
                1538-7445
                15 April 2022
                21 February 2022
                : 82
                : 8
                : 1448-1460
                Affiliations
                [1 ]Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
                [2 ]Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon.
                [3 ]Department of Medicine, University of California, San Francisco, San Francisco, California.
                [4 ]Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.
                [5 ]Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, California.
                [6 ]Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
                [7 ]Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
                [8 ]Department of Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, Minnesota.
                [9 ]Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
                [10 ]Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.
                [11 ]Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
                [12 ]Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington.
                [13 ]Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington.
                [14 ]Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York City, New York.
                [15 ]Howard Hughes Medical Institute, Chevy Chase, Maryland.
                [16 ]Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
                Author notes
                [#]

                J.W. Tyner, F. Haderk, A. Kumaraswamy, L.B. Baughn, B. Van Ness, S. Liu, and H. Marathe contributed equally to this article.

                [* ] Corresponding Author: Jeffrey W. Tyner, Division of Hematology and Medical Oncology, Knight Cancer Institute, Department of Cell, Development and Cancer Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. E-mail: tynerj@ 123456ohsu.edu

                Cancer Res 2022;82:1448–60

                Author information
                https://orcid.org/0000-0002-2133-0960
                https://orcid.org/0000-0002-9997-7430
                https://orcid.org/0000-0003-1278-0166
                https://orcid.org/0000-0001-8331-8206
                https://orcid.org/0000-0002-7353-5650
                https://orcid.org/0000-0002-5451-5726
                https://orcid.org/0000-0003-4955-6475
                https://orcid.org/0000-0001-9953-0279
                Article
                CAN-21-3695
                10.1158/0008-5472.CAN-21-3695
                9018544
                35195258
                4b2e8b9c-e2af-4ef3-990e-2a9f10936854
                ©2022 The Authors; Published by the American Association for Cancer Research

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs International 4.0 License.

                History
                : 29 October 2021
                : 21 January 2022
                : 15 February 2022
                Page count
                Pages: 13
                Funding
                Funded by: NCI, DOI http://dx.doi.org/10.13039/100000054;
                Award ID: U54 CA224019
                Award ID: U54 CA224079
                Award ID: U54 CA224081
                Award ID: U54 CA224018
                Award ID: U54 CA224068
                Award ID: U01 CA217885-03S1
                Award ID: R01 CA131261-09S2
                Award ID: U54 CA224065-02
                Award ID: R01 CA207757-03S1
                Award ID: R01 CA192844-04S1
                Award ID: R37 CA230617-02S1
                Award ID: U01 CA223976-03S1
                Award ID: P50 CA186786-07S1
                Award ID: U01 CA231776-03S1
                Award ID: R01 CA175397-07S1
                Award ID: U24 CA232979
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