Do mutator mutations fuel tumorigenesis?
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The mutator phenotype hypothesis proposes that the mutation rate of normal cells is insufficient to account for the large number of mutations found in human cancers. Consequently, human tumors exhibit an elevated mutation rate that increases the likelihood of a tumor acquiring advantageous mutations. The hypothesis predicts that tumors are composed of cells harboring hundreds of thousands of mutations, as opposed to a small number of specific driver mutations, and that malignant cells within a tumor therefore constitute a highly heterogeneous population. As a result, drugs targeting specific mutated driver genes or even pathways of mutated driver genes will have only limited anticancer potential. In addition, because the tumor is composed of such a diverse cell population, tumor cells harboring drug-resistant mutations will exist prior to the administration of any chemotherapeutic agent. We present recent evidence in support of the mutator phenotype hypothesis, major arguments against this concept, and discuss the clinical consequences of tumor evolution fueled by an elevated mutation rate. We also consider the therapeutic possibility of altering the rate of mutation accumulation. Most significantly, we contend that there is a need to fundamentally reconsider current approaches to personalized cancer therapy. We propose that targeting cellular pathways that alter the rate of mutation accumulation in tumors will ultimately prove more effective than attempting to identify and target mutant driver genes or driver pathways.
KeywordsMutator phenotype Mutation Heterogeneity Cancer genome sequencing Tumor evolution
We would like to thank Ashwini Kamath-Loeb and Kate Bayliss-Reid for critical reading of the manuscript and other Loeb lab members for helpful discussions. We thank Diana Lim for constructing Fig. 1. The authors apologize to colleagues whose valuable work, while uncited in this review, has enormous impact on the field. LAL is supported by R01-CA102029, R01-CA160674, and P01-CA077852 from the NCI and P01-AG-033061 from the NIA.
Conflict of interest
The authors declare no conflict(s) of interest.
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