# Keep them asleep: dormancy maintenance as adjuvant therapy

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

## TL;DR

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.

## Summary

This idea proposes dormancy maintenance as adjuvant therapy: keep hidden cancer cells dormant for life with low-toxicity drugs rather than trying to kill them all, as extended hormone therapy already does in breast cancer. Extended Endocrine therapy (SERMs, AIs, SERDs) and adjuvant CDK4/6 inhibitors may work partly by enforcing dormancy, and 5-azacytidine plus ATRA induced NR2F1 in a prostate pilot (Tumour dormancy pathway). The hypothesis is that a dormancy-enforcing regimen given for 3-5 years to patients positive for Minimal / molecular residual disease (MRD) delays or prevents relapse with less toxicity than cytotoxic escalation. The test is a randomised phase 2 in MRD-positive early Prostate cancer or HR-positive / HER2-negative breast cancer.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Tags: mechanism; open-question
- 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.
- Proposed test: 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

## Sources

- Sosa, Bragado and Aguirre-Ghiso, Mechanisms of disseminated cancer cell dormancy: an awakening field (Nature Reviews Cancer 2014): https://doi.org/10.1038/nrc3793

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [Endocrine therapy (SERMs, AIs, SERDs)](https://onco.cc/technologies/endocrine-therapy/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- institutions: [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/), [The Mount Sinai Hospital / Tisch Cancer Institute](https://onco.cc/institutions/mount-sinai/)
- pathways: [Oestrogen receptor signalling](https://onco.cc/pathways/er-signaling/), [The metastatic cascade](https://onco.cc/pathways/metastatic-cascade/), [Tumour dormancy](https://onco.cc/pathways/tumor-dormancy/)
- terms: [Late recurrence](https://onco.cc/terms/late-recurrence/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- key papers: [Mechanisms of disseminated cancer cell dormancy: an awakening field](https://onco.cc/key-papers/paper-sosa-nat-rev-cancer/)

---
JSON: https://onco.cc/api/v1/entities/idea-dormancy-maintenance-therapy.json