{"entity":{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","aka":["Metastatic Cancer","Secondary cancer","Advanced cancer","Stage 4 cancer","Stage IV cancer","Cancer that has spread"],"tldr":"Metastatic cancer means the original cancer has spread to other parts of the body, most often the bones, liver, lungs or brain. It keeps the name of where it started, is treated with therapies that reach the whole body, and can increasingly be controlled for years; with limited spread it is sometimes treated with the aim of cure.","summary":"Metastasis is the process by which cancer cells leave the original tumour, travel through blood or lymph and grow in another organ. A breast cancer that has spread to the liver is still breast cancer and is treated with breast cancer drugs, which is why this page points to the cancer-specific pages for treatment. What metastatic cancers share is the intent and the tools: systemic therapy (chemotherapy, targeted drugs, hormone therapy, immunotherapy) rather than surgery alone; radiotherapy and bone-strengthening drugs for bone metastases; radiosurgery or surgery for brain metastases; and early palliative care alongside treatment, which improves quality of life and in some studies survival. Two ideas have changed the outlook: many metastatic cancers are now chronic conditions controlled for years, and oligometastatic disease, spread limited to a few sites, is increasingly treated with stereotactic radiotherapy or surgery to every site with the aim of long remission, as the SABR-COMET trial suggested. Circulating tumour DNA is beginning to detect and monitor spread from a blood sample.","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Metastasis","links":[{"label":"NCI: Metastatic cancer","url":"https://www.cancer.gov/types/metastatic-cancer"}],"tags":["umbrella"],"related":["cancer-of-unknown-primary","secondary-brain-tumours","bone-metastases","brain-metastases","leptomeningeal-disease","oligometastatic","sabr-comet"],"cancers":[],"sections":[],"technologies":["sbrt","stereotactic-radiosurgery","palliative-radiotherapy","bone-modifying-agents","palliative-care","ctdna"],"targets":[],"drugs":["zoledronic-acid","denosumab","radium-223"],"companies":[],"institutions":[],"pathways":[],"terms":["metastasis","oligometastatic","bone-metastases","brain-metastases","leptomeningeal-disease","palliative-treatment"],"trials":["alliance-n0574","nrg-cc001","horrad","nct06174987","nct06506955","nct04914598","nct06081959","nct04464226","nct05501886","nct06994507","nct05774951","nct04906395","nct05296798","nct07648264","nct05814354","nct07672236","nct02763566","nct06312176","nct06062810","nct06343948","nct05696626","nct03148418","nct07060807","nct05262010","nct06635447","nct05112965","nct06652633","nct07541079","nct02320435","nct06492616","nct04895358","nct07499674","nct04170283","nct04862663","nct05909397","nct05514054","nct03315364","nct06867705","nct05629234","nct07405164","nct06313983","nct06764186","nct07290088","nct05257395","nct06041061","nct05864014","nct05827081","nct04514419","nct03435796","nct07648914","nct07071337","nct06632912","nct03815643","nct04639986","nct04851613","nct03980054","nct06072612"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"other","burden":"Most cancer deaths follow metastasis rather than growth of the original tumour; how often a cancer spreads, and where, depends on the primary site.","subtypes":[],"biomarkers":["Imaging (CT, PET, MRI) and biopsy of a metastatic site to confirm the primary and re-test targets","Circulating tumour DNA","Site-specific markers such as bone scan uptake or alkaline phosphatase"],"standardOfCare":[{"setting":"Widespread metastatic disease","approach":"Systemic therapy chosen by the primary cancer and its biomarkers, with early palliative care; see the individual cancer pages.","refs":["palliative-care"]},{"setting":"Oligometastatic disease","approach":"Stereotactic ablative radiotherapy or surgery to all sites in addition to systemic therapy, in selected patients and ideally in trials.","refs":["sbrt"]},{"setting":"Bone metastases","approach":"Palliative radiotherapy for pain, bone-modifying agents (zoledronic acid or denosumab) to prevent fractures, radium-223 in prostate cancer.","refs":["palliative-radiotherapy","bone-modifying-agents","zoledronic-acid","denosumab","radium-223"]},{"setting":"Brain metastases","approach":"Stereotactic radiosurgery for limited lesions, surgery for large symptomatic ones, and brain-penetrant targeted drugs where a driver exists.","refs":["stereotactic-radiosurgery"]}],"stateOfArt":["Oligometastatic disease can be treated for long-term control: in SABR-COMET, adding stereotactic radiotherapy to every metastasis (one to five sites) raised five-year overall survival from 17.7 to 42.3 percent, at the cost of some serious toxicity; phase 3 trials are confirming it.","Treatment is chosen by the tumour's biology, not only its origin: pembrolizumab for mismatch-repair-deficient or high-mutation-burden tumours (2017), larotrectinib and entrectinib for NTRK fusions, dabrafenib with trametinib for BRAF V600E, selpercatinib for RET, and trastuzumab deruxtecan for HER2-positive tumours of any site are approved regardless of where the cancer began.","Metastases to bone and brain have their own standards: bone-modifying agents and single-fraction palliative radiotherapy for bone, stereotactic radiosurgery rather than whole-brain radiotherapy for limited brain metastases, and brain-penetrant targeted drugs where a driver exists.","Early palliative care alongside cancer treatment improves quality of life and mood and does not shorten life; guidelines now recommend it from diagnosis of advanced disease."],"history":[{"year":1995,"title":"Oligometastasis proposed","note":"Hellman and Weichselbaum argue that some patients have a limited metastatic state that local treatment could control, the idea SABR-COMET later tested.","refs":["sbrt"]},{"year":2010,"title":"Early palliative care trial","note":"Temel and colleagues randomise newly diagnosed metastatic lung cancer patients to early palliative care with standard oncology: better quality of life, less depression and no loss of survival.","refs":["palliative-care"]},{"year":2017,"title":"First tissue-agnostic approval","note":"Pembrolizumab is approved for any solid tumour with mismatch-repair deficiency or microsatellite instability, the first cancer drug approved by biomarker rather than organ.","refs":["pembrolizumab"]},{"year":2020,"title":"SABR-COMET long-term results","note":"Five-year survival more than doubles with stereotactic radiotherapy to all metastases in the randomised phase 2 trial.","refs":["sabr-comet"]},{"year":1889,"title":"Paget's seed and soil hypothesis","note":"Stephen Paget proposed that cancers spread to organs whose environment suits them, the founding idea of metastasis research.","refs":[]},{"year":2002,"title":"Zoledronic acid approved for bone metastases","note":"Bisphosphonates, then denosumab, cut fractures and other skeletal events from bone metastases.","refs":["zoledronic-acid","denosumab"]},{"year":2019,"title":"SABR-COMET reports","note":"Randomised phase 2 trial in which stereotactic radiotherapy to all sites of oligometastatic disease was associated with longer survival, launching phase 3 trials of the approach.","refs":["sbrt"]}],"pipeline":["sabr-comet","sbrt","ctdna","pembrolizumab","larotrectinib","entrectinib","dabrafenib","trametinib","selpercatinib","dostarlimab","trastuzumab-deruxtecan","tst001","merestinib","au-007","or502","wjb001","mhb039a","mhb036c","samuraciclib","camonsertib","selicrelumab","fluzoparib","evexomostat","obi-902","farletuzumab-ecteribulin","imp1734","skb105","avzo-023","tqb3909","obi-992","rnk05047","inlexisertib","ipg1094","hst-1011","evm14"],"openProblems":["Metastasis itself has no approved drug: treatments target the growing cells, not the spreading.","Which patients with limited spread truly benefit from treating every site is still being tested in phase 3 trials."]},"route":"/cancers/metastatic-cancer/","neighbours":{"cancer":[{"id":"secondary-brain-tumours","kind":"cancer","name":"Brain metastases (secondary brain tumours)","route":"/cancers/secondary-brain-tumours/"},{"id":"cancer-of-unknown-primary","kind":"cancer","name":"Cancer of unknown primary (CUP)","route":"/cancers/cancer-of-unknown-primary/"},{"id":"cup-unfavourable","kind":"cancer","name":"Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma)","route":"/cancers/cup-unfavourable/"},{"id":"spinal-cord-tumours","kind":"cancer","name":"Spinal cord tumours (intramedullary and intradural)","route":"/cancers/spinal-cord-tumours/"}],"term":[{"id":"bone-metastases","kind":"term","name":"Bone metastases and skeletal-related events","route":"/terms/bone-metastases/"},{"id":"brain-metastases","kind":"term","name":"Brain metastases (intracranial disease)","route":"/terms/brain-metastases/"},{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"leptomeningeal-disease","kind":"term","name":"Leptomeningeal disease","route":"/terms/leptomeningeal-disease/"},{"id":"metastasis","kind":"term","name":"Metastasis","route":"/terms/metastasis/"},{"id":"oligometastatic","kind":"term","name":"Oligometastatic disease","route":"/terms/oligometastatic/"},{"id":"palliative-treatment","kind":"term","name":"Palliative","route":"/terms/palliative-treatment/"},{"id":"radiation-necrosis","kind":"term","name":"Radiation necrosis (brain)","route":"/terms/radiation-necrosis/"},{"id":"stereotactic-radiosurgery","kind":"term","name":"Stereotactic radiosurgery (SRS)","route":"/terms/stereotactic-radiosurgery/"}],"trial":[{"id":"nct04632108","kind":"trial","name":"A 1/2 Phase Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Antitumor Activity of ASKB589 in Patients With Locally Advanced or Metastatic Solid Tumors","route":"/trials/nct04632108/"},{"id":"nct06341114","kind":"trial","name":"A Clinical Study Evaluating the Safety, Tolerability, Pharmacokinetic Characteristics, and Preliminary 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