Robert Gatenby

Robert Gatenby pioneered adaptive therapy, a revolutionary approach to managing drug resistance by exploiting evolutionary dynamics and competitive fitness costs of resistance, rather than attempting maximal tumor kill. His mathematical models and clinical trials demonstrated that maintaining a stable population of drug-sensitive cells that compete with resistant clones can prolong disease control compared to conventional maximum-dose therapy. He showed that resistant cells carry fitness costs in the absence of drug pressure, providing the biological basis for treatment holidays in adaptive therapy. His evolutionary approach to cancer drug resistance has challenged decades of maximum tolerated dose paradigms.