Dormancy
Disseminated cells can sleep for years, held quiet by their niche and watched by immune cells, then wake after inflammation, injury or ageing. Late relapse in breast and prostate cancer is dormancy ending.
Diagram
Pick a product above a diagram to see the nodes it hits and the escape routes below the block. Hover or tap any node or arrow for what it is; every node opens its target, glossary entry or the pathway page. Violet boxes are druggable targets.
Seeds that stay in the soil for years waiting for the right spring. You can keep the ground cold (maintenance therapy), force them to sprout and mow them (wake-and-kill), or dig them out (immune clearance).
What happens
In plain words, then the glossary entries the stage rests on. Chapter 7, Invasion and metastasis: Metastasis causes about nine in ten cancer deaths, and no approved drug targets it directly.
Disseminated cells can sleep for years, held quiet by their niche and watched by immune cells, then wake after inflammation, injury or ageing. Late relapse in breast and prostate cancer is dormancy ending.
Tumour dormancy. Cancer cells can hide in bone marrow, lung, or brain for years or decades, asleep and invisible to scans and chemotherapy, then wake up. Late relapse in breast and prostate cancer is dormancy ending.
The molecular players
The proteins and genes at this stage, with their role and how many products act on each. Listed players come from the atlas; drawn players sit as nodes in the diagrams above.
No target record is listed at this stage or drawn in its diagrams; the pathways above carry the mechanism.
Where medicines act
Products grouped by the node they hit, most advanced first, with the cancers an approved product is linked to. Pick one above the diagram to see it light up.
No product in the corpus acts on a target at this stage yet.
How tumours escape
Records tied to this stage that describe resistance, evasion or tolerance. The resistance atlas lists the routes class by class.
- early clinicaldataA national residual-disease weather service: serial blood tests for every curatively treated patient, pooled
After surgery or curative treatment, everyone gets regular blood tests for leftover cancer DNA, and the pooled results power forecasts of who will relapse and trials of acting early.
- early clinicalctDNA-guided adjuvant therapy in stage II-III melanoma
Most stage II patients never relapse, yet all are offered a year of immunotherapy. Use a blood test to treat only those with detectable residual disease.
- early clinicalregulatorFormally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials
If a blood test reliably shows whether cancer will come back after surgery, trials could use it instead of waiting years for relapse. Regulators have a process to bless such a test; oncology should use it.
- early clinicalHPV circulating tumour DNA to guide cervical cancer therapy
Because cervical tumours carry viral DNA that normal cells do not, a blood test for HPV DNA is a near-perfect tumour marker for tracking response and relapse.
- early clinicalKeep 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.
- early clinicalindustryPersonalised vaccines given only when the blood test turns positive
Individualised mRNA cancer vaccines take weeks to manufacture and work best against minimal residual disease. Making the vaccine at surgery and giving it only when a blood tumour DNA test turns positive matches both facts and concentrates the cost on the minority who will relapse.
- early clinicalclinicRead the spinal fluid to track brain tumours without opening the skull
Fluid taken from the lower back contains DNA from brain tumours. Testing it can diagnose, monitor and detect resistance without brain surgery.
- early clinicalresearchStrip the platelet coat off travelling tumour cells in ctDNA-positive patients
Cancer cells in the blood wrap themselves in platelets as camouflage. Aspirin may remove that cloak, and it is cheapest to test in the patients at highest risk of relapse.
- preclinical evidenceengineeringA bone marrow niche on a chip to study human dormancy
Dormant cancer cells hide in bone marrow. A lab-built model of that hiding place would let us watch them sleep and wake, and test drugs on them.
- preclinical evidenceresearchBreak the neutrophil DNA nets that catch tumour cells after surgery
Surgery makes some immune cells throw out sticky DNA webs that trap travelling cancer cells and help them settle. Dissolving those webs during the operation might prevent some relapses.
- 2026translationalc-TRAK TN analysis: tissue-free versus tumour-informed ctDNA assays for residual disease in early triple-negative breast cancerJAMA Oncology
- 2025rctChildren's Oncology Group AALL1731: blinatumomab added to chemotherapy for children with standard-risk B-cell ALLNew England Journal of Medicinechanged practice
- 2024rctNATALEE: three years of ribociclib after surgery in a broad population of hormone-receptor-positive early breast cancerNew England Journal of Medicinechanged practice
- 2024rctNIAGARA: durvalumab before and after cystectomy for muscle-invasive bladder cancerNew England Journal of Medicinechanged practice
- 2023observationalGALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfoldNature Medicine
- 2023translationalTRACERx 421: the full-cohort picture of how lung cancer evolves and which subclones drive relapseNature
Measured by
Biomarkers, tests and assays in the corpus that read this stage in a patient.
Open questions
What is not known at this stage: the atlas's own questions, the bottlenecks it bears on, and the ideas in the corpus that try to answer them.
- Should we wake dormant cells to kill them, or keep them asleep for life?
- What wakes them: surgery, infection, inflammation, ageing?
- being tested at scalepolicyA national platform trial that every ctDNA-positive patient can join
Blood tests can now find leftover cancer months before scans, but most patients who test positive have nothing to enrol in. One standing trial per country would fix that.
- being tested at scalectDNA-guided adjuvant therapy as the default in stage II-III colon cancer
Use a blood test after surgery to decide who gets chemotherapy: spare the negatives, and find something that actually works for the positives.
- early clinicalresearchAn independent programme that validates surrogate endpoints, setting by setting
Trials often measure a stand-in for survival, such as time until the cancer grows on scans. An independent body would test, for each cancer and treatment type, whether the stand-in actually predicts survival, and publish the answer.
- early clinicalresearchBlock the recycling that keeps dormant cells alive
Sleeping cancer cells survive by recycling their own contents. An old malaria drug blocks that recycling and is being tested in people with no visible cancer but detectable residual cells.
- early clinicalregulatorCertified reference samples to benchmark every tumour-DNA blood test
Dozens of companies sell blood tests for tumour DNA and they report different results on the same sample. Government-issued reference samples with known amounts of tumour DNA would expose the differences.
- early clinicalindustryCirculating tumour cell clearance as the phase 2 gate for anti-metastatic drugs
Cancer cells travelling in the blood can be counted. If a drug clears them, that is an early sign it may stop spread, and it reads out in weeks rather than years.
- early clinicalctDNA-guided escalation and de-escalation in frontline DLBCL
Use an ultra-sensitive blood test after two cycles to decide who needs more than R-CHOP and who can stop early.
- early clinicalctDNA-triggered escalation in early TNBC
Instead of treating everyone after surgery, test blood every few months and treat only when tumour DNA reappears.
- early clinicalpayerOutcome-based annuity payments for potentially curative one-time therapies
Instead of paying hundreds of thousands up front for a CAR-T or gene therapy, the health system would pay in yearly instalments that stop if the cancer comes back, so companies are paid for cures, not attempts.
- early clinicalindustryPersonalised cancer vaccines at commodity cost through fully automated manufacturing
Vaccines tailored to each patient's tumour mutations are showing real benefit but cost a fortune to make. Automate the whole process so a personalised vaccine costs about as much as a course of chemotherapy.
26 more ideas are linked to this stage's pathways, targets and terms; see the rankings →
Key evidence
Papers in the corpus tied to this stage's pathways, targets and terms, newest first.
- 2026translationalc-TRAK TN analysis: tissue-free versus tumour-informed ctDNA assays for residual disease in early triple-negative breast cancerJAMA Oncology
- 2025rctAMPLIFY: fixed-duration acalabrutinib plus venetoclax, with or without obinutuzumab, versus chemo-immunotherapy in fit CLL patientsNew England Journal of Medicinechanged practice
- 2025rctCEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpointNature Medicinechanged practice
- 2025rctChildren's Oncology Group AALL1731: blinatumomab added to chemotherapy for children with standard-risk B-cell ALLNew England Journal of Medicinechanged practice
- 2025rctIMvigor011: using a blood test for leftover cancer to decide who gets immunotherapy after bladder surgeryNew England Journal of Medicinechanged practice
- 2024rctECOG-ACRIN E1910: adding blinatumomab to chemotherapy for adults with B-cell ALL already in MRD-negative remissionNew England Journal of Medicinechanged practice
- 2024rctNATALEE: three years of ribociclib after surgery in a broad population of hormone-receptor-positive early breast cancerNew England Journal of Medicinechanged practice
- 2024rctNIAGARA: durvalumab before and after cystectomy for muscle-invasive bladder cancerNew England Journal of Medicinechanged practice
- 2024rctPERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myelomaNew England Journal of Medicinechanged practice
- 2023observationalGALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfoldNature Medicine
- 2023translationalTRACERx 421: the full-cohort picture of how lung cancer evolves and which subclones drive relapseNature
- 2022rctCheckMate 816: three cycles of nivolumab plus chemotherapy before lung cancer surgeryNew England Journal of Medicinechanged practice
src/data/mechanics-atlas.ts). Players, medicines, escape routes, tests, ideas and papers are resolved from the knowledge graph at build time through the stage's pathways, targets and terms, so every item here has its own page and sources. Where a section is missing, the corpus has no record tied to the stage yet. Nothing here is medical advice; see about and methodology. Stage 7.5 of 56.