{"entity":{"id":"idea-bio2-oligometastatic-signature","kind":"idea","name":"A test to tell true oligometastatic disease from hidden widespread spread","aka":[],"tldr":"Some people have only a few sites of spread and can be treated at each one; others have further deposits not yet visible, and counting lesions cannot tell them apart. A signature built from tumour DNA levels, microRNA classifiers and clonal diversity across lesions would define the biology and spare futile ablation.","summary":"Ablative treatment of all visible lesions improves survival in selected patients, but selection today is anatomical and therefore crude. Candidate discriminators include ctDNA level and clearance kinetics, microRNA classifiers reported in oligometastatic lung cancer, and clonal diversity across lesions. A locked signature, prospectively validated, would define the biology rather than the lesion count.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Metastasis is understood least and studied last): Dillekås et al., Are 90% of deaths from cancer caused by metastases? (Cancer Medicine 2019)","url":"https://doi.org/10.1002/cam4.2474"}],"tags":[],"related":["idea-psma-pet-guided-mdt"],"cancers":["nsclc","prostate","colorectal"],"sections":[],"technologies":["sbrt","mrd-testing","liquid-biopsy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["oligometastatic","oligoprogression","ctdna"],"trials":[],"people":[],"bottlenecks":["b-metastasis-biology","b-biomarker-validation"],"keyPapers":["paper-dillekas-cancer-med"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A combined ctDNA-kinetic and transcriptomic signature identifies patients whose disease is genuinely restricted, in whom total metastasis-directed ablation gives two-year progression-free survival above 50%, against below 20% in signature-negative patients.","rationale":"The benefit of metastasis-directed therapy varies enormously and unpredictably, which is the signature of a mixed population. Analogous molecular refinement transformed adjuvant chemotherapy decisions in breast cancer through genomic assays.","test":"Embed a locked biomarker panel in an ongoing metastasis-directed radiotherapy trial with a pre-specified interaction analysis; a null interaction kills the signature cheaply.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":5},"route":"/ideas/idea-bio2-oligometastatic-signature/","neighbours":{"idea":[{"id":"idea-psma-pet-guided-mdt","kind":"idea","name":"PSMA-PET-guided metastasis-directed therapy as a curative strategy in oligorecurrent prostate cancer","route":"/ideas/idea-psma-pet-guided-mdt/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"oligometastatic","kind":"term","name":"Oligometastatic disease","route":"/terms/oligometastatic/"},{"id":"oligoprogression","kind":"term","name":"Oligoprogression","route":"/terms/oligoprogression/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-metastasis-biology","kind":"bottleneck","name":"Metastasis is understood least and studied last","route":"/bottlenecks/b-metastasis-biology/"}],"paper":[{"id":"paper-dillekas-cancer-med","kind":"paper","name":"Are 90% of deaths from cancer caused by metastases?","route":"/key-papers/paper-dillekas-cancer-med/"},{"id":"paper-gundem-evolutionary-history-lethal-metastatic-prostate-nature-2015","kind":"paper","name":"The evolutionary history of lethal metastatic prostate cancer","route":"/key-papers/paper-gundem-evolutionary-history-lethal-metastatic-prostate-nature-2015/"}]}}