OnCo
ideasIdea

Keep dormant cells asleep instead of trying to kill them

If we cannot kill sleeping cancer cells, we could try to keep them asleep for life. That would turn residual cancer into a harmless passenger.

Dormancy is an active transcriptional programme involving NR2F1, SOX9, TGF-beta2 and retinoic acid signalling. Combination all-trans retinoic acid plus a hypomethylating agent restored NR2F1 and enforced dormancy in head and neck and breast models from the Aguirre-Ghiso group, and both drugs are approved and cheap. The clinical question is whether enforced dormancy is durable and tolerable for years.

Hypothesis
Low-dose retinoid plus hypomethylating therapy in ctDNA-positive survivors keeps ctDNA stable or falling and delays radiographic relapse compared with observation, without cumulative toxicity.
Rationale
Prostate and breast cancers already prove that decades-long dormancy is a natural state, so the biology has an existence proof. Pro-dormancy is also a lower bar than eradication and may be achievable with well-characterised generic agents.
What would test it
A randomised phase 2 in ctDNA-positive survivors with ctDNA trajectory as primary endpoint, plus marrow NR2F1 staining as pharmacodynamic proof of mechanism.
Maturity
preclinical evidence
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
9
Bottlenecks it attacks

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