OnCo
ideasIdea

Keep them asleep: dormancy maintenance as adjuvant therapy

Instead of trying to kill every hidden cancer cell after surgery, keep them dormant for life with low-toxicity drugs, the way extended hormone therapy already does in breast cancer.

Extended endocrine therapy and adjuvant CDK4/6 inhibitors may work partly by enforcing dormancy; 5-azacytidine plus ATRA induced NR2F1 and delayed progression in a prostate pilot.

Hypothesis
A dormancy-enforcing regimen given for 3-5 years after curative therapy in MRD-positive patients delays or prevents relapse compared with observation, with less toxicity than cytotoxic escalation.
Rationale
Dormancy biology is now mechanistically defined; MRD assays identify who needs it; ER+ breast cancer shows the principle works clinically.
What would test it
Randomised phase 2 in MRD-positive early prostate or breast cancer: dormancy regimen vs observation, primary endpoint time to ctDNA/clinical relapse; embed DTC state biomarkers.
Maturity
early clinical

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cancers

2
HR-positive / HER2-negative breast cancerProstate cancer

technologies

2
Endocrine therapy (SERMs, AIs, SERDs)MRD / molecular residual disease testing

institutions

2
Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer CenterThe Mount Sinai Hospital / Tisch Cancer Institute

pathways

3
Oestrogen receptor signallingThe metastatic cascadeTumour dormancy

terms

2
Late recurrenceMinimal / molecular residual disease (MRD)