Reuniting philosophy and science to advance cancer research.

Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental and clinical) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer.

[An analysis of medical decision making: The case of multidisciplinary team meetings]. / Une analyse de la prise de décision médicale lors des réunions de concertations pluridisciplinaires.

Practitioners provide patients with the best possible diagnostic and/or therapeutic decision. This assertion implies that the medical decision must be based on two criteria: in accordance with the current state of science and to offer patients the best benefit/risk ratio. In the field of oncology, multidisciplinary team meetings aim to promote the best possible medical decision-making by imposing collective and interdisciplinary decision-making. They must therefore allow a decision in accordance with the current state of science in each of the disciplines represented. The aim of this article is to clarify what it means to make the best possible decision in the context of multidisciplinary team meetings. We will thus try to identify the conditions that make it possible to ensure collective and interdisciplinary medical decision-making based on the two criteria previously mentioned. First, we will study two theoretical propositions from the literature in the humanities and social sciences. Then, based on observations from several multidisciplinary team meetings, we will assess the relevance of these proposals for the analysis of interdisciplinary and collective medical decisions. We will underline the limits of these proposals and will identify other conditions for better understanding and ensuring "the best possible medical decision" in the specific context of multidisciplinary team meetings in oncology.

Perspective: plasticity, the enemy of the good.

Plasticity is an important feature of modern cancer research. However, the level at which we should consider it remains an open question. Such debate is not new in the field of cancer and can be exemplified by the different models explaining carcinogenesis. Those models mostly explain cell transformation through the deregulation of the internal circuitry. In the last years, those models dramatically increased our knowledge and led to a series of short-term successes in terms of therapeutics. However, cancer drug resistance inevitably arises. Recently, studies on the so-called tumor microenvironment enriched the cell-centered perspective but it also enlarged the complexity of cancer etiology in particular for advanced diseases. Here, we suggest that the plastic and multi-sites specific nature of cancer combined with our incapacity to promise cure should push towards a new perspective where early clinical actions, instead of late ones, should be heralded as the priority of cancer research and care.