Breast cancer recurrence, sometimes decades after initial treatment, is driven by dormant cancer cells that evade therapy. Researchers are focusing on understanding these cells and the “treatment window” between initial therapy and potential reawakening. Dormant cells often reside in protective niches, like bone marrow, where surrounding cells shield them from treatment. Key survival mechanisms include autophagy, mTOR signaling, and epigenetic modifications. Inflammation can act as a “wake-up call,” triggering dormant cells to resume growth.
Recent advances allow detection of these hidden cells through minimal residual disease (MRD) screening, often using bone marrow samples. Repurposed FDA-approved drugs targeting autophagy and mTOR pathways have shown promise in clearing dormant cells in preclinical models.
Clinical trials, such as the Phase II CLEVER study, demonstrate that identifying and treating dormant cells can dramatically reduce recurrence rates. This approach marks a paradigm shift, focusing not just on primary tumor removal but actively preventing breast cancer relapse.