“…Even worse, treatment can promote metastasis and cancer lethality (D'Alterio et al, 2020 ; Pienta et al, 2020a , b ). There are many viewpoints/assumptions to explain the mechanisms of drug resistance: multiple drug resistance, cancer stem cells, cellular adaptation and collaboration, epigenetic regulation, cancer heterogenicity, persistent cancer cells, exosomal non-coding RNAs, acquired immune-resistance, and tumor micro-environments including tumor-stromal cross-talk (Heng et al, 2010 ; Holohan et al, 2013 ; Keating et al, 2013 ; Niero et al, 2014 ; Restifo et al, 2016 ; Cho and Kim, 2020 ; Guo et al, 2020 ; Shen et al, 2020 ; Swayden et al, 2020 ; Bhattacharya et al, 2021 ). Among them, new gene mutations and, in particular, selection of preexisting variants by drug treatment are the most popular mechanisms of cancer drug resistance (Khong and Restifo, 2002 ; Aktipis et al, 2011 ; Heng, 2015 , 2019 ).…”