{"entity":{"id":"idea-bio2-premetastatic-niche-assay","kind":"idea","name":"A blood test for the pre-metastatic niche","aka":[],"tldr":"Before cancer spreads, distant organs are changed to become welcoming. A test for those changes would show which organ is at risk while a person still looks cancer-free.","summary":"Pre-metastatic niche formation involves tumour-derived exosome integrins, S100A8 and S100A9 induction, myeloid mobilisation and fibronectin deposition in the target organ. Candidate readouts exist (plasma S100A8/A9, exosomal integrin profiles, circulating LOX activity, neutrophil trajectories) but nobody has assembled them into a validated organ-specific risk assay.","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":[],"cancers":["colorectal","breast-hr-positive","pancreatic"],"sections":[],"technologies":["proteomics","liquid-biopsy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-metastasis-biology","b-dormancy-mrd","b-biomarker-validation"],"keyPapers":["paper-dillekas-cancer-med"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A multi-analyte niche score measured after curative surgery predicts organ-specific relapse (lung versus liver versus bone) with a c-statistic above 0.75, independently of and additively to ctDNA.","rationale":"Exosomal integrin patterns predicted lung and liver organotropism respectively in mouse and human samples. Organ-specific prediction would let prevention be targeted to one organ, which a single ctDNA yes-or-no answer cannot do.","test":"Nested case-control study in two existing adjuvant trial biobanks with known relapse sites; lock the score, then validate it prospectively in a third cohort.","maturity":"speculative","actor":"research","cost":"medium","horizonYears":7},"route":"/ideas/idea-bio2-premetastatic-niche-assay/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"proteomics","kind":"technology","name":"Proteomics & phosphoproteomics","route":"/technologies/proteomics/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"},{"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/"}]}}