Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

The dormant cancer cell life cycle

Abstract

The success of targeted therapies and immunotherapies has created optimism that cancers may be curable. However, not all patients respond, drug resistance is common and many patients relapse owing to dormant cancer cells. These rare and elusive cells can disseminate early and hide in specialized niches in distant organs before being reactivated to cause disease relapse after successful treatment of the primary tumour. Despite their importance, we are yet to leverage knowledge generated from experimental models and translate the potential of targeting dormant cancer cells to prevent disease relapse in the clinic. This is due, at least in part, to the lack of adherence to consensus definitions by researchers, limited models that faithfully recapitulate this stage of metastatic spread and an absence of interdisciplinary approaches. However, the application of new high-resolution, single-cell technologies is starting to revolutionize the field and transcend classical reductionist models of studying individual cell types or genes in isolation to provide a global view of the complex underlying cellular ecosystem and transcriptional landscape that controls dormancy. In this Perspective, we synthesize some of these recent advances to describe the hallmarks of cancer cell dormancy and how the dormant cancer cell life cycle offers opportunities to target not only the cancer but also its environment to achieve a durable cure for seemingly incurable cancers.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Brief history of cancer cell dormancy.
Fig. 2: Model of cancer cell dormancy.
Fig. 3: Habitats and niches for dormant cancer cells.
Fig. 4: Dormant cancer cell life cycle and the hallmarks of cancer cell dormancy.
Fig. 5: Targeting the dormant cancer cell life cycle.

Similar content being viewed by others

References

  1. Lambert, A. W., Pattabiraman, D. R. & Weinberg, R. A. Emerging biological principles of metastasis. Cell 168, 670–691 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Dillekas, H., Rogers, M. S. & Straume, O. Are 90% of deaths from cancer caused by metastases? Cancer Med. 8, 5574–5576 (2019).

    PubMed  PubMed Central  Google Scholar 

  3. Friberg, S. & Nystrom, A. Cancer metastases: early dissemination and late recurrences. Cancer Growth Metastasis 8, 43–49 (2015).

    PubMed  PubMed Central  Google Scholar 

  4. Pan, H. et al. 20-Year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N. Engl. J. Med. 377, 1836–1846 (2017).

    PubMed  PubMed Central  Google Scholar 

  5. Celsus, A. C. Celsus, de Medicina / With an English Translation by W.G. Spencer (Harvard Univ. Press, 1935).

  6. Willis, R. A. The Spread of Tumours in the Human Body (J. & A. Churchill, 1934).

  7. Hadfield, G. The dormant cancer cell. Br. Med. J. 2, 607–610 (1954).

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Holmgren, L., O’Reilly, M. S. & Folkman, J. Dormancy of micrometastases: balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nat. Med. 1, 149–153 (1995).

    CAS  PubMed  Google Scholar 

  9. Townson, J. L. & Chambers, A. F. Dormancy of solitary metastatic cells. Cell Cycle 5, 1744–1750 (2006).

    CAS  PubMed  Google Scholar 

  10. Reya, T., Morrison, S. J., Clarke, M. F. & Weissman, I. L. Stem cells, cancer, and cancer stem cells. Nature 414, 105–111 (2001).

    CAS  PubMed  Google Scholar 

  11. Coller, H. A., Sang, L. & Roberts, J. M. A new description of cellular quiescence. PLOS Biol. 4, e83 (2006).

    PubMed  PubMed Central  Google Scholar 

  12. Coller, H. A. Cell biology. The essence of quiescence. Science 334, 1074–1075 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Gimbrone, M. A. Jr., Leapman, S. B., Cotran, R. S. & Folkman, J. Tumor dormancy in vivo by prevention of neovascularization. J. Exp. Med. 136, 261–276 (1972).

    PubMed  PubMed Central  Google Scholar 

  14. Vallette, F. M. et al. Dormant, quiescent, tolerant and persister cells: four synonyms for the same target in cancer. Biochem. Pharmacol. 162, 169–176 (2019).

    CAS  PubMed  Google Scholar 

  15. Kleinsmith, L. J. & Pierce, G. B. Jr. Multipotentiality of single embryonal carcinoma cells. Cancer Res. 24, 1544–1551 (1964).

    CAS  PubMed  Google Scholar 

  16. Pierce, G. B. & Speers, W. C. Tumors as caricatures of the process of tissue renewal: prospects for therapy by directing differentiation. Cancer Res. 48, 1996–2004 (1988).

    CAS  PubMed  Google Scholar 

  17. Lapidot, T. et al. A cell initiating human acute myeloid leukaemia after transplantation into SCID mice. Nature 367, 645–648 (1994).

    CAS  PubMed  Google Scholar 

  18. Al-Hajj, M., Wicha, M. S., Benito-Hernandez, A., Morrison, S. J. & Clarke, M. F. Prospective identification of tumorigenic breast cancer cells. Proc. Natl Acad. Sci. USA 100, 3983–3988 (2003).

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Visvader, J. E. & Lindeman, G. J. Cancer stem cells in solid tumours: accumulating evidence and unresolved questions. Nat. Rev. Cancer 8, 755–768 (2008).

    CAS  PubMed  Google Scholar 

  20. Clevers, H. The cancer stem cell: premises, promises and challenges. Nat. Med. 17, 313–319 (2011).

    CAS  PubMed  Google Scholar 

  21. Sosa, M. S. et al. NR2F1 controls tumour cell dormancy via SOX9- and RARβ-driven quiescence programmes. Nat. Commun. 6, 6170 (2015).

    CAS  PubMed  Google Scholar 

  22. Khoo, W. H. et al. A niche-dependent myeloid transcriptome signature defines dormant myeloma cells. Blood 134, 30–43 (2019).

    CAS  PubMed  Google Scholar 

  23. Lawson, M. A. et al. Osteoclasts control reactivation of dormant myeloma cells by remodelling the endosteal niche. Nat. Commun. 6, 8983 (2015).

    CAS  PubMed  Google Scholar 

  24. Aguirre-Ghiso, J. A., Estrada, Y., Liu, D. & Ossowski, L. ERK(MAPK) activity as a determinant of tumor growth and dormancy; regulation by p38(SAPK). Cancer Res. 63, 1684–1695 (2003).

    CAS  PubMed  Google Scholar 

  25. Oki, T. et al. A novel cell-cycle-indicator, mVenus-p27K, identifies quiescent cells and visualizes G0–G1 transition. Sci. Rep. 4, 4012 (2014).

    PubMed  PubMed Central  Google Scholar 

  26. Carlson, P. et al. Targeting the perivascular niche sensitizes disseminated tumour cells to chemotherapy. Nat. Cell Biol. 21, 238–250 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Chambers, A. F. et al. Steps in tumor metastasis: new concepts from intravital videomicroscopy. Cancer Metastasis Rev. 14, 279–301 (1995).

    CAS  PubMed  Google Scholar 

  28. Sipkins, D. A. et al. In vivo imaging of specialized bone marrow endothelial microdomains for tumour engraftment. Nature 435, 969–973 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Hawkins, E. D. et al. T-cell acute leukaemia exhibits dynamic interactions with bone marrow microenvironments. Nature 538, 518–522 (2016).

    PubMed  PubMed Central  Google Scholar 

  30. Boyerinas, B. et al. Adhesion to osteopontin in the bone marrow niche regulates lymphoblastic leukemia cell dormancy. Blood 121, 4821–4831 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Shiozawa, Y. et al. Human prostate cancer metastases target the hematopoietic stem cell niche to establish footholds in mouse bone marrow. J. Clin. Invest. 121, 1298–1312 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Ghajar, C. M. et al. The perivascular niche regulates breast tumour dormancy. Nat. Cell Biol. 15, 807–817 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Price, T. T. et al. Dormant breast cancer micrometastases reside in specific bone marrow niches that regulate their transit to and from bone. Sci. Transl Med. 8, 340ra373 (2016).

    Google Scholar 

  34. Blunt, T. et al. Defective DNA-dependent protein kinase activity is linked to V(D)J recombination and DNA repair defects associated with the murine scid mutation. Cell 80, 813–823 (1995).

    CAS  PubMed  Google Scholar 

  35. Qing, Y., Lin, Y. & Gerson, S. L. An intrinsic BM hematopoietic niche occupancy defect of HSC in scid mice facilitates exogenous HSC engraftment. Blood 119, 1768–1771 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Carpenter, R. A., Kwak, J. G., Peyton, S. R. & Lee, J. Implantable pre-metastatic niches for the study of the microenvironmental regulation of disseminated human tumour cells. Nat. Biomed. Eng. 2, 915–929 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Weiss, L. Metastatic inefficiency. Adv. Cancer Res. 54, 159–211 (1990).

    CAS  PubMed  Google Scholar 

  38. Fidler, I. J. Metastasis: quantitative analysis of distribution and fate of tumor emboli labeled with 125I-5-iodo-2′-deoxyuridine. J. Natl Cancer Inst. 45, 773–782 (1970).

    CAS  PubMed  Google Scholar 

  39. Luzzi, K. J. et al. Multistep nature of metastatic inefficiency: dormancy of solitary cells after successful extravasation and limited survival of early micrometastases. Am. J. Pathol. 153, 865–873 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Paget, S. The distribution of secondary growths in cancer of the breast. Cancer Metastasis Rev. 8, 98–101 (1889).

    Google Scholar 

  41. Weaver, V. M. et al. Reversion of the malignant phenotype of human breast cells in three-dimensional culture and in vivo by integrin blocking antibodies. J. Cell Biol. 137, 231–245 (1997).

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Schofield, R. The relationship between the spleen colony-forming cell and the haemopoietic stem cell. Blood Cell 4, 7–25 (1978).

    CAS  Google Scholar 

  43. Ossowski, L. & Reich, E. Changes in malignant phenotype of a human carcinoma conditioned by growth environment. Cell 33, 323–333 (1983).

    CAS  PubMed  Google Scholar 

  44. Shiozawa, Y., Havens, A. M., Pienta, K. J. & Taichman, R. S. The bone marrow niche: habitat to hematopoietic and mesenchymal stem cells, and unwitting host to molecular parasites. Leukemia 22, 941–950 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Peled, A. et al. Dependence of human stem cell engraftment and repopulation of NOD/SCID mice on CXCR4. Science 283, 845–848 (1999).

    CAS  PubMed  Google Scholar 

  46. Nie, Y., Han, Y. C. & Zou, Y. R. CXCR4 is required for the quiescence of primitive hematopoietic cells. J. Exp. Med. 205, 777–783 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Tzeng, Y. S. et al. Loss of Cxcl12/Sdf-1 in adult mice decreases the quiescent state of hematopoietic stem/progenitor cells and alters the pattern of hematopoietic regeneration after myelosuppression. Blood 117, 429–439 (2011).

    CAS  PubMed  Google Scholar 

  48. Kawabata, K. et al. A cell-autonomous requirement for CXCR4 in long-term lymphoid and myeloid reconstitution. Proc. Natl Acad. Sci. USA 96, 5663–5667 (1999).

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Zhang, J. et al. Identification of the haematopoietic stem cell niche and control of the niche size. Nature 425, 836–841 (2003).

    CAS  PubMed  Google Scholar 

  50. Calvi, L. M. et al. Osteoblastic cells regulate the haematopoietic stem cell niche. Nature 425, 841–846 (2003).

    CAS  PubMed  Google Scholar 

  51. Hooper, A. T. et al. Engraftment and reconstitution of hematopoiesis is dependent on VEGFR2-mediated regeneration of sinusoidal endothelial cells. Cell Stem Cell 4, 263–274 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Sugiyama, T., Kohara, H., Noda, M. & Nagasawa, T. Maintenance of the hematopoietic stem cell pool by CXCL12–CXCR4 chemokine signaling in bone marrow stromal cell niches. Immunity 25, 977–988 (2006).

    CAS  PubMed  Google Scholar 

  53. Omatsu, Y. et al. The essential functions of adipo-osteogenic progenitors as the hematopoietic stem and progenitor cell niche. Immunity 33, 387–399 (2010).

    CAS  PubMed  Google Scholar 

  54. Ding, L., Saunders, T. L., Enikolopov, G. & Morrison, S. J. Endothelial and perivascular cells maintain haematopoietic stem cells. Nature 481, 457–462 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Mendez-Ferrer, S. et al. Mesenchymal and haematopoietic stem cells form a unique bone marrow niche. Nature 466, 829–834 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Hanoun, M. & Frenette, P. S. This niche is a maze; an amazing niche. Cell Stem Cell 12, 391–392 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Greenbaum, A. et al. CXCL12 in early mesenchymal progenitors is required for haematopoietic stem-cell maintenance. Nature 495, 227–230 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Gong, J. K. Endosteal marrow: a rich source of hematopoietic stem cells. Science 199, 1443–1445 (1978).

    CAS  PubMed  Google Scholar 

  59. Wei, Q. & Frenette, P. S. Niches for hematopoietic stem cells and their progeny. Immunity 48, 632–648 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Vora, A. J., Toh, C. H., Peel, J. & Greaves, M. Use of granulocyte colony-stimulating factor (G-CSF) for mobilizing peripheral blood stem cells: risk of mobilizing clonal myeloma cells in patients with bone marrow infiltration. Br. J. Haematol. 86, 180–182 (1994).

    CAS  PubMed  Google Scholar 

  61. Vogel, W., Kopp, H. G., Kanz, L. & Einsele, H. Myeloma cell contamination of peripheral blood stem-cell grafts can predict the outcome in multiple myeloma patients after high-dose chemotherapy and autologous stem-cell transplantation. J. Cancer Res. Clin. Oncol. 131, 214–218 (2005).

    PubMed  Google Scholar 

  62. Fischer, J. C. et al. Diagnostic leukapheresis enables reliable detection of circulating tumor cells of nonmetastatic cancer patients. Proc. Natl Acad. Sci. USA 110, 16580–16585 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Nahi, H., Celanovic, M., Liu, Q., Lund, J. & Peceliunas, V. A pilot, exploratory, randomized, phase II safety study evaluating tumor cell mobilization and apheresis product contamination in patients treated with granulocyte colony-stimulating factor alone or plus plerixafor. Biol. Blood Marrow Transplant. 25, 34–40 (2019).

    CAS  PubMed  Google Scholar 

  64. Gooding, S. et al. Transcriptomic profiling of the myeloma bone-lining niche reveals BMP signalling inhibition to improve bone disease. Nat. Commun. 10, 4533 (2019).

    PubMed  PubMed Central  Google Scholar 

  65. Tikhonova, A. N. et al. The bone marrow microenvironment at single-cell resolution. Nature 569, 222–228 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Baryawno, N. et al. A cellular taxonomy of the bone marrow stroma in homeostasis and leukemia. Cell 177, 1915–1932.e16 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Herault, A. et al. Myeloid progenitor cluster formation drives emergency and leukaemic myelopoiesis. Nature 544, 53–58 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Burgess, D. J. Spatial transcriptomics coming of age. Nat. Rev. Genet. 20, 317 (2019).

    CAS  PubMed  Google Scholar 

  69. Nguyen, A., Khoo, W. H., Moran, I., Croucher, P. I. & Phan, T. G. Single cell RNA sequencing of rare immune cell populations. Front. Immunol. 9, 1553 (2018).

    PubMed  PubMed Central  Google Scholar 

  70. Nguyen, D. X., Bos, P. D. & Massague, J. Metastasis: from dissemination to organ-specific colonization. Nat. Rev. Cancer 9, 274–284 (2009).

    CAS  PubMed  Google Scholar 

  71. Gao, Y. et al. Metastasis organotropism: redefining the congenial soil. Dev. Cell 49, 375–391 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Pavlovic, M. et al. Enhanced MAF oncogene expression and breast cancer bone metastasis. J. Natl Cancer Inst. 107, djv256 (2015).

    PubMed  PubMed Central  Google Scholar 

  73. Muller, A. et al. Involvement of chemokine receptors in breast cancer metastasis. Nature 410, 50–56 (2001).

    CAS  PubMed  Google Scholar 

  74. Taichman, R. S. et al. Use of the stromal cell-derived factor-1/CXCR4 pathway in prostate cancer metastasis to bone. Cancer Res. 62, 1832–1837 (2002).

    CAS  PubMed  Google Scholar 

  75. Takayama, S. et al. The relationship between bone metastasis from human breast cancer and integrin αvβ3 expression. Anticancer. Res. 25, 79–83 (2005).

    CAS  PubMed  Google Scholar 

  76. Sloan, E. K. et al. Tumor-specific expression of αvβ3 integrin promotes spontaneous metastasis of breast cancer to bone. Breast Cancer Res. 8, R20 (2006).

    PubMed  PubMed Central  Google Scholar 

  77. McCabe, N. P., De, S., Vasanji, A., Brainard, J. & Byzova, T. V. Prostate cancer specific integrin αvβ3 modulates bone metastatic growth and tissue remodeling. Oncogene 26, 6238–6243 (2007).

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Tomita, Y., Sachs, D. H. & Sykes, M. Myelosuppressive conditioning is required to achieve engraftment of pluripotent stem cells contained in moderate doses of syngeneic bone marrow. Blood 83, 939–948 (1994).

    CAS  PubMed  Google Scholar 

  79. Shimoto, M., Sugiyama, T. & Nagasawa, T. Numerous niches for hematopoietic stem cells remain empty during homeostasis. Blood 129, 2124–2131 (2017).

    CAS  PubMed  Google Scholar 

  80. Shiozawa, Y. et al. Annexin II/annexin II receptor axis regulates adhesion, migration, homing, and growth of prostate cancer. J. Cell. Biochem. 105, 370–380 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Semenza, G. L. Targeting HIF-1 for cancer therapy. Nat. Rev. Cancer 3, 721–732 (2003).

    CAS  PubMed  Google Scholar 

  82. Carcereri de Prati, A. et al. Metastatic breast cancer cells enter into dormant state and express cancer stem cells phenotype under chronic hypoxia. J. Cell. Biochem. 118, 3237–3248 (2017).

    CAS  PubMed  Google Scholar 

  83. Fluegen, G. et al. Phenotypic heterogeneity of disseminated tumour cells is preset by primary tumour hypoxic microenvironments. Nat. Cell Biol. 19, 120–132 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  84. Shiozawa, Y. et al. GAS6/AXL axis regulates prostate cancer invasion, proliferation, and survival in the bone marrow niche. Neoplasia 12, 116–127 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  85. Yumoto, K. et al. Axl is required for TGF-β2-induced dormancy of prostate cancer cells in the bone marrow. Sci. Rep. 6, 36520 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Adam, A. P. et al. Computational identification of a p38SAPK-regulated transcription factor network required for tumor cell quiescence. Cancer Res. 69, 5664–5672 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Bragado, P. et al. TGF-β2 dictates disseminated tumour cell fate in target organs through TGF-β-RIII and p38α/β signalling. Nat. Cell Biol. 15, 1351–1361 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  88. Pantel, K. & Brakenhoff, R. H. Dissecting the metastatic cascade. Nat. Rev. Cancer 4, 448–456 (2004).

    CAS  PubMed  Google Scholar 

  89. Valastyan, S. & Weinberg, R. A. Tumor metastasis: molecular insights and evolving paradigms. Cell 147, 275–292 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  90. Yates, L. R. et al. Genomic evolution of breast cancer metastasis and relapse. Cancer Cell 32, 169–184.e7 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  91. Riethmuller, G. & Klein, C. A. Early cancer cell dissemination and late metastatic relapse: clinical reflections and biological approaches to the dormancy problem in patients. Semin. Cancer Biol. 11, 307–311 (2001).

    CAS  PubMed  Google Scholar 

  92. Husemann, Y. et al. Systemic spread is an early step in breast cancer. Cancer Cell 13, 58–68 (2008).

    PubMed  Google Scholar 

  93. Hosseini, H. et al. Early dissemination seeds metastasis in breast cancer. Nature 540, 552–558 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  94. Hu, Z. et al. Quantitative evidence for early metastatic seeding in colorectal cancer. Nat. Genet. 51, 1113–1122 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  95. Hedberg, M. L. et al. Genetic landscape of metastatic and recurrent head and neck squamous cell carcinoma. J. Clin. Invest. 126, 169–180 (2016).

    PubMed  Google Scholar 

  96. Zehir, A. et al. Mutational landscape of metastatic cancer revealed from prospective clinical sequencing of 10,000 patients. Nat. Med. 23, 703–713 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  97. Robinson, D. R. et al. Integrative clinical genomics of metastatic cancer. Nature 548, 297–303 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  98. Dobson, S. M. et al. Relapse fated latent diagnosis subclones in acute B lineage leukaemia are drug tolerant and possess distinct metabolic programs. Cancer Discov. 10, 568–587 (2020).

    PubMed  PubMed Central  Google Scholar 

  99. Merino, D. et al. Barcoding reveals complex clonal behavior in patient-derived xenografts of metastatic triple negative breast cancer. Nat. Commun. 10, 766 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  100. Noorani, A. et al. Genomic evidence supports a clonal diaspora model for metastases of esophageal adenocarcinoma. Nat. Genet. 52, 74–83 (2020).

    CAS  PubMed  PubMed Central  Google Scholar 

  101. Harper, K. L. et al. Mechanism of early dissemination and metastasis in Her2+ mammary cancer. Nature 540, 588–592 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  102. Suzuki, M., Mose, E. S., Montel, V. & Tarin, D. Dormant cancer cells retrieved from metastasis-free organs regain tumorigenic and metastatic potency. Am. J. Pathol. 169, 673–681 (2006).

    CAS  PubMed  PubMed Central  Google Scholar 

  103. Crea, F., Nur Saidy, N. R., Collins, C. C. & Wang, Y. The epigenetic/noncoding origin of tumor dormancy. Trends Mol. Med. 21, 206–211 (2015).

    CAS  PubMed  Google Scholar 

  104. Sharma, S. V. et al. A chromatin-mediated reversible drug-tolerant state in cancer cell subpopulations. Cell 141, 69–80 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  105. Owen, K. L. et al. Prostate cancer cell-intrinsic interferon signaling regulates dormancy and metastatic outgrowth in bone. EMBO Rep. https://doi.org/10.15252/embr.202050162 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  106. Bidwell, B. N. et al. Silencing of Irf7 pathways in breast cancer cells promotes bone metastasis through immune escape. Nat. Med. 18, 1224–1231 (2012).

    CAS  PubMed  Google Scholar 

  107. Rankin, E. B. & Giaccia, A. J. The receptor tyrosine kinase AXL in cancer progression. Cancers 8, 103 (2016).

    PubMed Central  Google Scholar 

  108. Lu, X. et al. VCAM-1 promotes osteolytic expansion of indolent bone micrometastasis of breast cancer by engaging α4β1-positive osteoclast progenitors. Cancer Cell 20, 701–714 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  109. Gautier, E. L. et al. Gene-expression profiles and transcriptional regulatory pathways that underlie the identity and diversity of mouse tissue macrophages. Nat. Immunol. 13, 1118–1128 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  110. Teng, M. W., Swann, J. B., Koebel, C. M., Schreiber, R. D. & Smyth, M. J. Immune-mediated dormancy: an equilibrium with cancer. J. Leukoc. Biol. 84, 988–993 (2008).

    CAS  PubMed  Google Scholar 

  111. Goddard, E. T., Bozic, I., Riddell, S. R. & Ghajar, C. M. Dormant tumour cells, their niches and the influence of immunity. Nat. Cell Biol. 20, 1240–1249 (2018).

    CAS  PubMed  Google Scholar 

  112. Dighe, A. S., Richards, E., Old, L. J. & Schreiber, R. D. Enhanced in vivo growth and resistance to rejection of tumor cells expressing dominant negative IFNγ receptors. Immunity 1, 447–456 (1994).

    CAS  PubMed  Google Scholar 

  113. Kaplan, D. H. et al. Demonstration of an interferon γ-dependent tumor surveillance system in immunocompetent mice. Proc. Natl Acad. Sci. USA 95, 7556–7561 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  114. Smyth, M. J. et al. Perforin-mediated cytotoxicity is critical for surveillance of spontaneous lymphoma. J. Exp. Med. 192, 755–760 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  115. Dunn, G. P., Bruce, A. T., Ikeda, H., Old, L. J. & Schreiber, R. D. Cancer immunoediting: from immunosurveillance to tumor escape. Nat. Immunol. 3, 991–998 (2002).

    CAS  PubMed  Google Scholar 

  116. Dunn, G. P., Old, L. J. & Schreiber, R. D. The three Es of cancer immunoediting. Annu. Rev. Immunol. 22, 329–360 (2004).

    CAS  PubMed  Google Scholar 

  117. Koebel, C. M. et al. Adaptive immunity maintains occult cancer in an equilibrium state. Nature 450, 903–907 (2007).

    CAS  PubMed  Google Scholar 

  118. Teng, M. W. et al. Opposing roles for IL-23 and IL-12 in maintaining occult cancer in an equilibrium state. Cancer Res. 72, 3987–3996 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  119. Weinhold, K. J., Goldstein, L. T. & Wheelock, E. F. The tumor dormant state. Quantitation of L5178Y cells and host immune responses during the establishment and course of dormancy in syngeneic DBA/2 mice. J. Exp. Med. 149, 732–744 (1979).

    CAS  PubMed  Google Scholar 

  120. Weinhold, K. J., Miller, D. A. & Wheelock, E. F. The tumor dormant state. Comparison of L5178Y cells used to establish dormancy with those that emerge after its termination. J. Exp. Med. 149, 745–757 (1979).

    CAS  PubMed  Google Scholar 

  121. Matsuzawa, A., Takeda, Y., Narita, M. & Ozawa, H. Survival of leukemic cells in a dormant state following cyclophosphamide-induced cure of strongly immunogenic mouse leukemia (DL811). Int. J. Cancer 49, 303–309 (1991).

    CAS  PubMed  Google Scholar 

  122. Eyles, J. et al. Tumor cells disseminate early, but immunosurveillance limits metastatic outgrowth, in a mouse model of melanoma. J. Clin. Invest. 120, 2030–2039 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  123. Muller-Hermelink, N. et al. TNFR1 signaling and IFN-γ signaling determine whether T cells induce tumor dormancy or promote multistage carcinogenesis. Cancer Cell 13, 507–518 (2008).

    PubMed  Google Scholar 

  124. Vinay, D. S. et al. Immune evasion in cancer: mechanistic basis and therapeutic strategies. Semin. Cancer Biol. 35 (Suppl), S185–S198 (2015).

    PubMed  Google Scholar 

  125. Pantel, K. et al. Frequent down-regulation of major histocompatibility class I antigen expression on individual micrometastatic carcinoma cells. Cancer Res. 51, 4712–4715 (1991).

    CAS  PubMed  Google Scholar 

  126. Agudo, J. et al. Quiescent tissue stem cells evade immune surveillance. Immunity 48, 271–285.e5 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  127. Pommier, A. et al. Unresolved endoplasmic reticulum stress engenders immune-resistant, latent pancreatic cancer metastases. Science 360, eaao4908 (2018).

    PubMed  PubMed Central  Google Scholar 

  128. Roche, P. A. & Furuta, K. The ins and outs of MHC class II-mediated antigen processing and presentation. Nat. Rev. Immunol. 15, 203–216 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  129. Johnson, D. B. et al. Melanoma-specific MHC-II expression represents a tumour-autonomous phenotype and predicts response to anti-PD-1/PD-L1 therapy. Nat. Commun. 7, 10582 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  130. Rodig, S. J. et al. MHC proteins confer differential sensitivity to CTLA-4 and PD-1 blockade in untreated metastatic melanoma. Sci. Transl Med. 10, eaar3342 (2018).

    PubMed  Google Scholar 

  131. Johnson, D. B. et al. Tumor-specific MHC-II expression drives a unique pattern of resistance to immunotherapy via LAG-3/FCRL6 engagement. JCI Insight 3, e120360 (2018).

    PubMed Central  Google Scholar 

  132. Roemer, M. G. M. et al. Major histocompatibility complex class II and programmed death ligand 1 expression predict outcome after programmed death 1 blockade in classic Hodgkin lymphoma. J. Clin. Oncol. 36, 942–950 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  133. Axelrod, M. L., Cook, R. S., Johnson, D. B. & Balko, J. M. Biological consequences of MHC-II expression by tumor cells in cancer. Clin. Cancer Res. 25, 2392–2402 (2019).

    PubMed  Google Scholar 

  134. Winkler, I. G. et al. Bone marrow macrophages maintain hematopoietic stem cell (HSC) niches and their depletion mobilizes HSCs. Blood 116, 4815–4828 (2010).

    CAS  PubMed  Google Scholar 

  135. Chow, A. et al. Bone marrow CD169+ macrophages promote the retention of hematopoietic stem and progenitor cells in the mesenchymal stem cell niche. J. Exp. Med. 208, 261–271 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  136. Ehninger, A. & Trumpp, A. The bone marrow stem cell niche grows up: mesenchymal stem cells and macrophages move in. J. Exp. Med. 208, 421–428 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  137. Baixeras, E. et al. Characterization of the lymphocyte activation gene 3-encoded protein. A new ligand for human leukocyte antigen class II antigens. J. Exp. Med. 176, 327–337 (1992).

    CAS  PubMed  Google Scholar 

  138. Schreeder, D. M. et al. Cutting edge: FcR-like 6 is an MHC class II receptor. J. Immunol. 185, 23–27 (2010).

    CAS  PubMed  Google Scholar 

  139. Hemon, P. et al. MHC class II engagement by its ligand LAG-3 (CD223) contributes to melanoma resistance to apoptosis. J. Immunol. 186, 5173–5183 (2011).

    CAS  PubMed  Google Scholar 

  140. Baldridge, M. T., King, K. Y., Boles, N. C., Weksberg, D. C. & Goodell, M. A. Quiescent haematopoietic stem cells are activated by IFN-γ in response to chronic infection. Nature 465, 793–797 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  141. MacNamara, K. C. et al. Infection-induced myelopoiesis during intracellular bacterial infection is critically dependent upon IFN-γ signaling. J. Immunol. 186, 1032–1043 (2011).

    CAS  PubMed  Google Scholar 

  142. Wilkins, B. S. Histology of normal haemopoiesis: bone marrow histology. I. J. Clin. Pathol. 45, 645–649 (1992).

    CAS  PubMed  PubMed Central  Google Scholar 

  143. Fujisaki, J. et al. In vivo imaging of Treg cells providing immune privilege to the haematopoietic stem-cell niche. Nature 474, 216–219 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  144. Hirata, Y. et al. CD150high bone marrow Tregs maintain hematopoietic stem cell quiescence and immune privilege via adenosine. Cell Stem Cell 22, 445–453.e5 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  145. Cairns, R. A., Harris, I. S. & Mak, T. W. Regulation of cancer cell metabolism. Nat. Rev. Cancer 11, 85–95 (2011).

    CAS  PubMed  Google Scholar 

  146. Stine, Z. E., Walton, Z. E., Altman, B. J., Hsieh, A. L. & Dang, C. V. MYC, metabolism, and cancer. Cancer Discov. 5, 1024–1039 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  147. Pascual, G. et al. Targeting metastasis-initiating cells through the fatty acid receptor CD36. Nature 541, 41–45 (2017).

    CAS  PubMed  Google Scholar 

  148. Watt, M. J. et al. Suppressing fatty acid uptake has therapeutic effects in preclinical models of prostate cancer. Sci. Transl Med. 11, eaau5758 (2019).

    CAS  PubMed  Google Scholar 

  149. Luo, X. et al. Emerging roles of lipid metabolism in cancer metastasis. Mol. Cancer 16, 76 (2017).

    PubMed  PubMed Central  Google Scholar 

  150. Panigrahy, D. et al. Epoxyeicosanoids stimulate multiorgan metastasis and tumor dormancy escape in mice. J. Clin. Invest. 122, 178–191 (2012).

    CAS  PubMed  Google Scholar 

  151. Nakamura, K. et al. Dysregulated IL-18 is a key driver of immunosuppression and a possible therapeutic target in the multiple myeloma microenvironment. Cancer Cell 33, 634–648.e5 (2018).

    CAS  PubMed  Google Scholar 

  152. Ribas, A. Adaptive immune resistance: how cancer protects from immune attack. Cancer Discov. 5, 915–919 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  153. Ottewell, P. D. et al. Zoledronic acid has differential antitumor activity in the pre- and postmenopausal bone microenvironment in vivo. Clin. Cancer Res. 20, 2922–2932 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  154. Ottewell, P. D. et al. Castration-induced bone loss triggers growth of disseminated prostate cancer cells in bone. Endocr. Relat. Cancer 21, 769–781 (2014).

    CAS  PubMed  Google Scholar 

  155. Ottewell, P. D. et al. OPG-Fc inhibits ovariectomy-induced growth of disseminated breast cancer cells in bone. Int. J. Cancer 137, 968–977 (2015).

    CAS  PubMed  Google Scholar 

  156. Mundy, G. R. Mechanisms of bone metastasis. Cancer 80, 1546–1556 (1997).

    CAS  PubMed  Google Scholar 

  157. Gao, H. et al. The BMP inhibitor Coco reactivates breast cancer cells at lung metastatic sites. Cell 150, 764–779 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  158. Albrengues, J. et al. Neutrophil extracellular traps produced during inflammation awaken dormant cancer cells in mice. Science 361, eaao4227 (2018).

    PubMed  PubMed Central  Google Scholar 

  159. Aguirre Ghiso, J. A., Kovalski, K. & Ossowski, L. Tumor dormancy induced by downregulation of urokinase receptor in human carcinoma involves integrin and MAPK signaling. J. Cell Biol. 147, 89–104 (1999).

    CAS  PubMed  Google Scholar 

  160. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365, 1687–1717 (2005).

    Google Scholar 

  161. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03032406 (2020).

  162. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03400254 (2019).

  163. Ghajar, C. M. Metastasis prevention by targeting the dormant niche. Nat. Rev. Cancer 15, 238–247 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  164. Roboz, G. J. et al. Phase I trial of plerixafor combined with decitabine in newly diagnosed older patients with acute myeloid leukemia. Haematologica 103, 1308–1316 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  165. Ghobrial, I. M. et al. Phase I/II trial of the CXCR4 inhibitor plerixafor in combination with bortezomib as a chemosensitization strategy in relapsed/refractory multiple myeloma. Am. J. Hematol. 94, 1244–1253 (2019).

    CAS  PubMed  Google Scholar 

  166. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02478125 (2019).

  167. Hamidi, H. & Ivaska, J. Every step of the way: integrins in cancer progression and metastasis. Nat. Rev. Cancer 18, 533–548 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  168. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02424617 (2017).

  169. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02922777 (2019).

  170. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03649321 (2019).

  171. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02488408 (2017).

  172. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03965494 (2019).

  173. Kirane, A. et al. Warfarin blocks Gas6-mediated Axl activation required for pancreatic cancer epithelial plasticity and metastasis. Cancer Res. 75, 3699–3705 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  174. Rajotte, I., Hasanbasic, I. & Blostein, M. Gas6-mediated signaling is dependent on the engagement of its γ-carboxyglutamic acid domain with phosphatidylserine. Biochem. Biophys. Res. Commun. 376, 70–73 (2008).

    CAS  PubMed  Google Scholar 

  175. Sosa, M. S. Dormancy programs as emerging antimetastasis therapeutic alternatives. Mol. Cell Oncol. 3, e1029062 (2016).

    PubMed  Google Scholar 

  176. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03572387 (2019).

  177. Wilson, W. R. & Hay, M. P. Targeting hypoxia in cancer therapy. Nat. Rev. Cancer 11, 393–410 (2011).

    CAS  PubMed  Google Scholar 

  178. Pelicano, H., Martin, D. S., Xu, R. H. & Huang, P. Glycolysis inhibition for anticancer treatment. Oncogene 25, 4633–4646 (2006).

    CAS  PubMed  Google Scholar 

  179. Manjili, M. H. The inherent premise of immunotherapy for cancer dormancy. Cancer Res. 74, 6745–6749 (2014).

    CAS  PubMed  Google Scholar 

  180. Wang, H. F. et al. Targeting immune-mediated dormancy: a promising treatment of cancer. Front. Oncol. 9, 498 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  181. Krejcik, J. et al. Daratumumab depletes CD38+ immune regulatory cells, promotes T-cell expansion, and skews T-cell repertoire in multiple myeloma. Blood 128, 384–394 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  182. Asghar, U., Witkiewicz, A. K., Turner, N. C. & Knudsen, E. S. The history and future of targeting cyclin-dependent kinases in cancer therapy. Nat. Rev. Drug Discov. 14, 130–146 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  183. Coleman, R. et al. Adjuvant zoledronic acid in patients with early breast cancer: final efficacy analysis of the AZURE (BIG 01/04) randomised open-label phase 3 trial. Lancet Oncol. 15, 997–1006 (2014).

    CAS  PubMed  Google Scholar 

  184. Early Breast Cancer Trialists’ Collaborative Group. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet 386, 1353–1361 (2015).

    Google Scholar 

  185. Coleman, R. E. et al. Benefits and risks of adjuvant treatment with zoledronic acid in stage II/III breast cancer. 10 years follow-up of the AZURE randomized clinical trial (BIG 01/04). J. Bone Oncol. 13, 123–135 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  186. Coleman, R. et al. Effect of MAF amplification on treatment outcomes with adjuvant zoledronic acid in early breast cancer: a secondary analysis of the international, open-label, randomised, controlled, phase 3 AZURE (BIG 01/04) trial. Lancet Oncol. 18, 1543–1552 (2017).

    CAS  PubMed  Google Scholar 

  187. Morgan, G. J. et al. First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a randomised controlled trial. Lancet 376, 1989–1999 (2010).

    CAS  PubMed  Google Scholar 

  188. Sanfilippo, K. M. et al. Comparative effectiveness on survival of zoledronic acid versus pamidronate in multiple myeloma. Leuk. Lymphoma 56, 615–621 (2015).

    CAS  PubMed  Google Scholar 

  189. Smith, M. R. et al. Randomized controlled trial of early zoledronic acid in men with castration-sensitive prostate cancer and bone metastases: results of CALGB 90202 (Alliance). J. Clin. Oncol. 32, 1143–1150 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  190. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01545648 (2017).

  191. Smith, M. R. et al. Denosumab and bone-metastasis-free survival in men with castration-resistant prostate cancer: results of a phase 3, randomised, placebo-controlled trial. Lancet 379, 39–46 (2012).

    CAS  PubMed  Google Scholar 

  192. McDonald, M. M. et al. Inhibiting the osteocyte-specific protein sclerostin increases bone mass and fracture resistance in multiple myeloma. Blood 129, 3452–3464 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  193. Delgado-Calle, J. et al. Genetic deletion of Sost or pharmacological inhibition of sclerostin prevent multiple myeloma-induced bone disease without affecting tumor growth. Leukemia 31, 2686–2694 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  194. Eda, H. et al. Regulation of sclerostin expression in multiple myeloma by Dkk-1: a potential therapeutic strategy for myeloma bone disease. J. Bone Miner. Res. 31, 1225–1234 (2016).

    CAS  PubMed  Google Scholar 

  195. Hesse, E. et al. Sclerostin inhibition alleviates breast cancer-induced bone metastases and muscle weakness. JCI Insight 5, e125543 (2019).

    Google Scholar 

  196. Naumov, G. N. et al. Ineffectiveness of doxorubicin treatment on solitary dormant mammary carcinoma cells or late-developing metastases. Breast Cancer Res. Treat. 82, 199–206 (2003).

    CAS  PubMed  Google Scholar 

  197. Ranganathan, A. C., Zhang, L., Adam, A. P. & Aguirre-Ghiso, J. A. Functional coupling of p38-induced up-regulation of BiP and activation of RNA-dependent protein kinase-like endoplasmic reticulum kinase to drug resistance of dormant carcinoma cells. Cancer Res. 66, 1702–1711 (2006).

    CAS  PubMed  PubMed Central  Google Scholar 

  198. Minassian, L. M., Cotechini, T., Huitema, E. & Graham, C. H. Hypoxia-induced resistance to chemotherapy in cancer. Adv. Exp. Med. Biol. 1136, 123–139 (2019).

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by P. and V. Duncan and the National Health and Medical Research Council (1139237, 1104031 and 1140996), a Kay Stubbs Cancer Research Grant, Cancer Council New South Wales Grant, Prostate Cancer Foundation of Australia and The Movember Foundation. T.G.P. is a National Health and Medical Research Council Senior Research Fellow (1155678). P.I.C. is supported by Mrs J. Gibson and the Ernest Heine Family Foundation.

Author information

Authors and Affiliations

Authors

Contributions

Both T.G.P. and P.I.C. researched the data for the article, provided substantial contributions to discussions of the content and contributed equally to writing the article and to reviewing and editing the manuscript before submission.

Corresponding authors

Correspondence to Tri Giang Phan or Peter I. Croucher.

Ethics declarations

Competing interests

T.G.P. is a consultant of Imugene Pty Ltd. P.I.C. has grant funding and has been on advisory boards and speaker bureaus for Amgen Inc.

Additional information

Peer review information

Nature Reviews Cancer thanks J. J. Bravo-Cordero and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Phan, T.G., Croucher, P.I. The dormant cancer cell life cycle. Nat Rev Cancer 20, 398–411 (2020). https://doi.org/10.1038/s41568-020-0263-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41568-020-0263-0

This article is cited by

Search

Quick links

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer