Causes and costs in biological vs clinical resistance

This Wednesday, on These few lines, Rob Noble warned of the two different ways in which the term de novo resistance is used by biologists and clinicians. The biologist sees de novo resistance as new genetic resistance arising after treatment has started. The clinician sees de novo resistance as a tumour that is not responsive to treatment from the start. To make matters even more confusing, Hitesh Mistry points to a further interpretation among pharmocologists: they refer to the tumour remaining after a partial but incomplete response to treatment as de novo resistant. Clearly this is a mess!

But I think this is an informative mess. I don’t think it is a matter of people accidentally overloading the same word. Instead, I think it reflects a conceptual difference in how biologists and clinicians think about resistance. A difference that is a bit akin to the difference between reductive and effective theories. It is also a difference that I had to deal with during the revisions of our recent work on measuring the games played by treatment sensitive and treatment resistance non-small cell lung cancer (Kaznatcheev et al., 2018).