Abstract: The popular application of targeted antitumor agents has greatly improved the efficacies of tumor therapy. However, some patients develop drug resistance after the administration with them for six to twelve months, leading to the failure of treatment. The cause of it is mainly due to tumor heterogeneity. The genesis of tumor heterogeneity is closely associated with tumor stem cells, genetic instability, cell competition and stochastic events. There are a lot of mechanisms involved in the drug resistance to the targeted agents. Tumor heterogeneity and drug resistance are great challenges for precision oncology and are taken account for the process of research and development of new antitumor agents.