The Implications of Clonal Genome Evolution for Cancer Medicine

Large-scale DNA sequencing of cancer genomes has provided insight into the clonality of tumor cells, in addition to potential targets for new therapeutic approaches. This review article discusses how methods to detect tumor-cell clonality may come to inform clinical practice. Within the next 5 years, international efforts may characterize the distribution of clonally dominant somatic mutations (those present in the majority of cells within a cancer) in more than 21,000 cancers of diverse types. 1 A reduction in costs and improvements in technology have placed the sequencing of patients' tumors within practical reach. Preliminary results suggest that full characterization of cancer genomes can be accomplished in a clinically useful time frame. 2 , 3 Cancer genomics has been the subject of several recent reviews, 4 – 7 but these have not focused on the implications and opportunities afforded by the realization that cancers are composed . . .