What is the storage effect, why should it occur in cancers, and how can it inform cancer therapy?

Intratumor heterogeneity is a feature of cancer that is associated with progression, treatment resistance, and recurrence. However, the mechanisms that allow diverse cancer cell lineages to coexist remain poorly understood. The storage effect is a coexistence mechanism that has been proposed to explain the diversity of a variety of ecological communities, including coral reef fish, plankton and desert annual plants. Three ingredients are required for there to be a storage effect: 1) temporal variability in the environment, 2) buffered population growth, and 3) species-specific environmental responses. Here, we argue that these conditions are observed in cancers and that it is likely that the storage effect contributes to intratumor diversity. Data that show the temporal variation within the tumor microenvironment is needed to quantify how cancer cells respond to fluctuations in the tumor microenvironment and what impact this has on interactions among cancer cell types. The presence of a storage effect within a patients tumors could have substantial impact on how we understand and treat cancer.