Mutation load, functional overlap, and synthetic lethality in the evolution and treatment of cancer

Abstract The efficacy of conventional anti-cancer drugs is puzzling in view of the ubiquitous tissue distribution and vital nature of their targets. Differences in cell cycling rates are not thought sufficient to explain chemotherapeutic selectivity. I suggest an alternative possibility based on the combinatorial effects of mutations in cancer cells. This model incorporates the concepts of synthetic–lethal interactions and mutation loads to explain the drug sensitivity of cancer cells. From this perspective, drugs that target complex processes that utilize genetically redundant or overlapping components, such as DNA replication and chromosome segregation, offer attractive target opportunities.