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Issue 185: In the simplest sense, the ultimate goal of treating cancer is for the patient to remain alive. This is not synonymous with eradicating every tumor cell in the body. Similar to the failure of high-dose synthetic pesticides in agricultural pest management to result in “cured fields,” high dose treatments in metastatic disease rarely, if ever, result in a cure. So, until truly curative therapies are developed, the treatment of metastatic disease could greatly benefit from the development of a long-term management clinical paradigm that judiciously uses the plethora of therapies that are already available. Coined as “Integrated Metastatic Management,” this new clinical paradigm would draw heavily from the principles of agricultural pest management and could result in the slowing or curtailing of widespread resistance to treatment, reducing overall drug usage, and increasing the overall survival and quality of life of cancer patients. Read Jessica Cunningham’s dissertation here, or download her recent opinion piece about metastatic management published in Nature Ecology & Evolution.