# Eradicate dormant cancer cells: a programme to wake and kill or lock asleep disseminated cells

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

## TL;DR

Many relapses come from cancer cells that hid dormant for years. Find drugs that either force them awake so chemotherapy kills them, or keep them asleep for life.

## Summary

Disseminated tumour cells in bone marrow and other niches survive therapy in a quiescent state maintained by niche signals (TGF-beta 2, BMP, NR2F1, autophagy) and cause late relapse in breast, prostate and melanoma. Preclinical work shows both awakening strategies (sensitising to chemotherapy) and dormancy-enforcing strategies (NR2F1 agonists, 5-azacytidine plus retinoic acid, CDK4/6 inhibitors) can reduce metastasis. The proposal is a coordinated programme: standardised dormant-cell models, biomarkers of dormancy burden in patients (bone marrow and ctDNA), and adjuvant trials of dormancy-directed therapy in patients with detected disseminated cells.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A dormancy-directed adjuvant regimen reduces late relapse (beyond three years) in high-risk hormone-receptor-positive breast cancer by a third compared with standard endocrine therapy.
- Rationale: Late relapse is the dominant failure mode in several common cancers and no current therapy targets the dormant state; the biology is now tractable and measurable.
- Proposed test: Phase 2 randomised trial in patients with detectable disseminated tumour cells after standard adjuvant therapy, with disseminated cell clearance and distant recurrence as endpoints.
- Maturity: preclinical-evidence
- Actor: research

## Sources

- Bottleneck evidence (Dormant cells and minimal residual disease): Tie et al., ctDNA analysis guiding adjuvant therapy in stage II colon cancer (NEJM 2022): https://doi.org/10.1056/NEJMoa2200075

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Melanoma](https://onco.cc/cancers/melanoma/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [CDK4/6 inhibitors](https://onco.cc/technologies/cdk46-inhibitor/), [Epigenetic drugs (HDAC, DNMT, EZH2, IDH, menin, BET)](https://onco.cc/technologies/epigenetic-drugs/)
- terms: [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- 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/)

---
JSON: https://onco.cc/api/v1/entities/idea-moon-dormancy-eradication-programme.json