Progress in detection and treatment have drastically improved survival for early breast cancer patients. However, distant recurrence causes high mortality and is typically considered incurable. Cancer dissemination occurs via circulating tumor cells and up to 75% of breast cancer patients could harbor micrometastases at the time of diagnosis, while metastatic recurrence often occurs years to decades after treatment. During clinical latency, disseminated tumor cells (DTCs) can enter a state of cell cycle arrest or dormancy at distant sites, and are likely shielded from immune detection and treatment. While this is a challenge, it can also be seen as an outstanding opportunity to target dormant DTCs on time, before their transformation into lethal metastatic lesions.
Recently, our partner Prof. Nicola Aceto and his team at the Institute for Molecular Health Sciences of the ETH Zurich, have reviewed and discussed progress made in the understanding of DTC and dormancy biology in breast cancer. Strides in the mechanistic insights of these features have led to the identification of possible targeting strategies, yet, their integration into the clinical trial design is still uncertain. The authors suggest that incorporating minimally invasive liquid biopsies and rationally designed adjuvant therapies, targeting both proliferating and dormant tumor cells, may help to address current challenges and improve precision cancer care.