The contribution of evolutionary game theory to understanding and treating cancer

Evolutionary game theory mathematically conceptualizes and analyzes biological interactions where one9s fitness not only depends on one9s own traits, but also on the traits of others. Typically, the individuals are not overtly rational and do not select, but rather, inherit their traits. Cancer can be framed as such an evolutionary game, as it is composed of cells of heterogeneous types undergoing frequency-dependent selection. In this article, we first summarize existing works where evolutionary game theory has been employed in modeling cancer and improving its treatment. Some of these game-theoretic models suggest how one could anticipate and steer cancer9s eco-evolutionary dynamics into states more desirable for the patient via evolutionary therapies. Such therapies offer great promise for increasing patient survival and decreasing drug toxicity, as demonstrated by some recent studies and clinical trials. We discuss clinical relevance of the existing game-theoretic models of cancer and its treatment, and opportunities for future applications. We discuss the developments in cancer biology that are needed to better utilize the full potential of game-theoretic models. Ultimately, we demonstrate that viewing tumors with an evolutionary game theory approach has medically useful implications that can inform and create a lockstep between empirical findings, and mathematical modeling. We suggest that cancer progression is an evolutionary game and needs to be viewed as such.