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Issue 336: Despite demonstrating promising outcomes in the clinical trials, evolutionary cancer therapy (ECT) faces technical and cultural challenges in its clinical implementation. These challenges are related to the high resource demands of the approach, regulatory concerns and mistrust and resistance in the medical field. In our paper, we propose a systems approach to address those challenges. We claim that ECT implementation requires hearing different perspectives from the relevant healthcare stakeholders, conceptualizing the problem to create a shared vison and coming to consensus on the safe and feasible implementation strategy. These steps are illustrated in the figure. The picture was enhanced using ChatGPT.