As another implication of ideas presented in this review, interventions to favour decoy fitness peaks (such as NOTCH1 mutant clones in the oesophagus) could limit or delay the emergence of more malignant clones.104 Moreover, evolutionarily informed strategies for cancer treatment, such as adaptive therapy, which leverage competition from drug-sensitive cells to keep a cancer treatable, are also being developed.114,115 Traditionally, patients are treated with the goal of eliminating the most cancer burden possible, with treatment to the maximum tolerated dose. This evidence concerns the gene NOTCH1 and cancer.