Subpopulations of tumour cells can harbour unique mutations that crop up later in a tumour's lifetime, and these could lead to treatment resistance.

Tumours contain cells with distinct mutations. Charles Swanton of University College London and his colleagues analysed DNA sequence data from more than 2,500 people with cancer to find out which mutations can fuel the expansion of subpopulations of tumour cells. The team found that mutations that drive cancer growth tend to emerge early in a tumour's evolution, and are typically found throughout the tumour. But the mutations can also develop later, in small subpopulations of cells.

The results suggest that some tumours become resistant to therapy when small populations carrying resistance genes expand. Understanding which mutations are present in these smaller groups of cells could aid in the selection of therapies for individuals.

Sci. Transl. Med. 7, 283ra54 (2015)