Flush dormant cells out of bone marrow, then kill them
Sleeping cancer cells hide in bone marrow where drugs cannot reach them. Pushing them into the bloodstream on purpose, then treating, might clear them.
Disseminated tumour cells occupy the CXCL12-CXCR4 haematopoietic niche, which shields them from chemotherapy. Plerixafor is an approved CXCR4 antagonist used to mobilise stem cells. A deliberate mobilise-then-treat schedule — plerixafor followed within a day by an antibody-drug conjugate or T-cell engager while cells are in circulation — is testable with agents that already exist.
- Metastasis is understood least and studied last · Metastasis causes about nine in ten cancer deaths but gets a small fraction of research money and almost no trials of its own.
- Dormant cells and minimal residual disease · After a 'successful' treatment, cells can sleep for years then relapse. We can barely detect them and cannot target them.
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