Leveraging selection for function in tumor evolution: System-level cancer therapies.

Current cancer therapies often fail due to tumor heterogeneity and rapid resistance evolution. A new evolutionary framework, 'selection for function,' proposes that tumor progression is driven by group phenotypic composition (GPC) and its interaction with the microenvironment, not by individual cell traits. This perspective opens new therapeutic avenues: targeting the tumor's functional networks rather than individual cells. Real-time tracking of GPC changes could inform adaptive treatments, delaying progression and resistance. By integrating evolutionary and ecological principles with conventional therapies, this strategy aims to transform cancer from a fatal to a manageable chronic disease. Crucially, it does not necessarily require new drugs but offers a way to repurpose existing therapies to impair a tumor's evolutionary potential. By steering tumor evolution toward less aggressive states, this approach could improve prognosis and long-term patient survival compared to current methods. We argue that leveraging GPC dynamics represents a critical, yet underexplored, opportunity in oncology.