OnCo
ideasIdea

What decides which disseminated cells ever colonise?

Most cancer cells that spread die or sleep forever; a few grow into lethal metastases. Nobody can yet tell them apart, and doing so would show whom to treat after surgery.

Bone marrow DTCs are common yet late relapse occurs in a minority. Candidate determinants: intrinsic stemness/plasticity programmes, niche interactions (perivascular, osteoblastic), immune surveillance capacity, and stochastic awakening.

Hypothesis
A measurable DTC state (e.g., NR2F1-low, proliferation-primed, immune-evasive) present at surgery predicts late metastasis independently of stage and could be targeted with dormancy-enforcing therapy.
Rationale
Aguirre-Ghiso's NR2F1 dormancy programme, MSK latency-competent cell work, and TRACERx show dissemination is early and heterogeneous; MRD assays now let DTC biology be followed clinically.
What would test it
Prospective cohort with bone marrow DTC single-cell profiling plus serial ctDNA in stage II-III breast cancer, correlating DTC state with 10-year distant recurrence; nested randomised dormancy-maintenance trial (5-azacytidine + ATRA) in DTC-positive patients.
Maturity
preclinical evidence

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