# Break the neutrophil DNA nets that catch tumour cells after surgery

Source: https://onco.cc/ideas/idea-bio2-net-blockade-perioperative/  
OnCo record `idea-bio2-net-blockade-perioperative` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

Neutrophil extracellular traps capture circulating tumour cells and promote liver and lung seeding in multiple mouse models, and trap markers rise sharply after large cancer operations. DNase I is an approved inhaled drug and PAD4 inhibitors are in development, so a perioperative net-dissolving window trial is quick and cheap to run.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Perioperative net degradation with DNase or a PAD4 inhibitor reduces postoperative ctDNA positivity at four weeks by a third after colorectal or pancreatic resection, and lowers two-year distant relapse.
- Rationale: The postoperative period is a brief, defined window of raised metastatic risk, and neutrophil traps are one of the few molecular explanations for it that already has drugs in hand and measurable pharmacodynamics.
- Proposed test: A 120-patient randomised window trial in colorectal liver resection or pancreatic resection with day-28 ctDNA as primary endpoint and trap markers such as citrullinated histone H3 as pharmacodynamic readouts.
- Maturity: preclinical-evidence
- Actor: research

## Sources

- Bottleneck evidence (Metastasis is understood least and studied last): Dillekås et al., Are 90% of deaths from cancer caused by metastases? (Cancer Medicine 2019): https://doi.org/10.1002/cam4.2474

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/)
- people: [Erik Sahai](https://onco.cc/people/erik-sahai/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/)
- key papers: [Are 90% of deaths from cancer caused by metastases?](https://onco.cc/key-papers/paper-dillekas-cancer-med/)

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