{"entity":{"id":"idea-dormancy-maintenance-therapy","kind":"idea","name":"Keep them asleep: dormancy maintenance as adjuvant therapy","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Sosa, Bragado and Aguirre-Ghiso, Mechanisms of disseminated cancer cell dormancy: an awakening field (Nature Reviews Cancer 2014)","url":"https://doi.org/10.1038/nrc3793"}],"tags":["mechanism","open-question"],"related":[],"cancers":["prostate","breast-hr-positive"],"sections":[],"technologies":["mrd-testing","endocrine-therapy"],"targets":[],"drugs":[],"companies":[],"institutions":["mount-sinai","johns-hopkins"],"pathways":["tumor-dormancy","metastatic-cascade","er-signaling"],"terms":["mrd","late-recurrence"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-sosa-nat-rev-cancer"],"journals":[],"dependsOn":[],"notes":[],"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.","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"},"route":"/ideas/idea-dormancy-maintenance-therapy/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"endocrine-therapy","kind":"technology","name":"Endocrine therapy (SERMs, AIs, SERDs)","route":"/technologies/endocrine-therapy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"institution":[{"id":"johns-hopkins","kind":"institution","name":"Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center","route":"/institutions/johns-hopkins/"},{"id":"mount-sinai","kind":"institution","name":"The Mount Sinai Hospital / Tisch Cancer Institute","route":"/institutions/mount-sinai/"}],"pathway":[{"id":"er-signaling","kind":"pathway","name":"Oestrogen receptor signalling","route":"/pathways/er-signaling/"},{"id":"metastatic-cascade","kind":"pathway","name":"The metastatic cascade","route":"/pathways/metastatic-cascade/"},{"id":"tumor-dormancy","kind":"pathway","name":"Tumour dormancy","route":"/pathways/tumor-dormancy/"}],"term":[{"id":"late-recurrence","kind":"term","name":"Late recurrence","route":"/terms/late-recurrence/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"paper":[{"id":"paper-sosa-nat-rev-cancer","kind":"paper","name":"Mechanisms of disseminated cancer cell dormancy: an awakening field","route":"/key-papers/paper-sosa-nat-rev-cancer/"}]}}