癌细胞的改变和适应能力对确定治疗方案提出了严峻的挑战。人们从遗传学角度对肿瘤进化进行了广泛的研究，以指导临床医生根据患者的突变谱选择最合适的治疗方案。然而，一些研究报告称，肿瘤可以在不改变其基因组成的情况下进化到更具侵袭性的阶段或对治疗产生耐药性。事实上，一些细胞内在和细胞外在的机制有助于肿瘤的进化。在这个观点中，我重点关注染色质、表观遗传和转录变化如何促进肿瘤进化，从而使癌细胞转变为不同的细胞状态并绕过对治疗的反应。尽管肿瘤非遗传进化更难追踪和预测，但了解其原理可能会带来新的治疗机会。© 2024 作者。约翰·威利出版的《分子肿瘤学》

The ability of cancer cells to change and adapt poses a critical challenge to identifying curative solutions. Tumor evolution has been extensively studied from a genetic perspective, to guide clinicians in selecting the most appropriate therapeutic option based on a patient's mutational profile. However, several studies reported that tumors can evolve toward more aggressive stages or become resistant to therapies without changing their genetic makeup. Indeed, several cell-intrinsic and cell-extrinsic mechanisms contribute to tumor evolution. In this viewpoint, I focus on how chromatin, epigenetic, and transcriptional changes contribute to tumor evolution, allowing cancer cells to transition to different cell states and bypass response to therapies. Although tumor nongenetic evolution is harder to trace and predict, understanding its principles might open new therapeutic opportunities.© 2024 The Author(s). Molecular Oncology published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.