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

Cancer is a significant global health issue, with treatment challenges arising from intratumor heterogeneity. This heterogeneity stems mainly from somatic evolution, causing genetic diversity within the tumor, and phenotypic plasticity of tumor cells leading to reversible phenotypic changes. However, the interplay of both factors has not been rigorously investigated. Here, we examine the complex relationship between somatic evolution and phenotypic plasticity, explicitly focusing on the interplay between cell migration and proliferation. This type of phenotypic plasticity is essential in glioblastoma, the most aggressive form of brain tumor. We propose that somatic evolution alters the regulation of phenotypic plasticity in tumor cells, specifically the reaction to changes in the microenvironment. We study this hypothesis using a novel, spatially explicit model that tracks individual cells' phenotypic and genetic states. We assume cells change between migratory and proliferative states controlled by inherited and mutation-driven genotypes and the cells' microenvironment. We observe that cells at the tumor edge evolve to favor migration over proliferation and vice versa in the tumor bulk. Notably, different genetic configurations can result in this pattern of phenotypic heterogeneity. We analytically predict the outcome of the evolutionary process, showing that it depends on the tumor microenvironment. Synthetic tumors display varying levels of genetic and phenotypic heterogeneity, which we show are predictors of tumor recurrence time after treatment. Interestingly, higher phenotypic heterogeneity predicts poor treatment outcomes, unlike genetic heterogeneity. Our research offers a novel explanation for heterogeneous patterns of tumor recurrence in glioblastoma patients. 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.