Reacción a "Reactions to study that identifies cells responsible for colon cancer relapse "

This work may represent a before and after in the understanding of metastatic colon cancer. Cancer is an organized cellular crime. For several years now we have known that not all cells within a tumor are the same, that they have hierarchies and can perform different and complementary tasks. Thanks to novel technologies that make it possible to study within a tumor which genes are turned on or off cell by cell, individually, this team of Spanish scientists led by Eduard Batlle has identified cells with a high capacity for relapse that are responsible for the appearance of metastasis in the liver and lung when the primary tumor was thought to be localized and had been completely extirpated.  

These cells are very rare and this work alerts us that they are disseminated in many patients in whom we might think that their tumor was very localized and had been removed with surgery and current treatments.  

This study describes the genetic characteristics of these cells with a high capacity for relapse, which will allow us to understand their peculiarities, develop diagnostic methods and also find their vulnerabilities in order to develop new therapies. In this aspect, Batlle's team has taken a big step forward. They have developed experimental models in mice that mimic the tumor and the clinic (surgery and current treatments). These models make it possible to study them, to know them well in order to be able to attack them, and they have discovered that they can be sensitive to immunotherapy in the early stages, when the tumor was still thought to be localized, before operating and starting current treatments.  

At that time, these cells that have already spread have not adapted the microenvironment to protect themselves. This contribution can be a revolution and raises a revision of the clinical guidelines in the treatment of this type of cancer because, in many cases, the application of neoadjuvant immunotherapy [before surgery] or future treatments aimed at attacking these cells should be considered.  

Curing is more urgent than understanding, but in order to cure it is necessary to understand. This work provides knowledge to understand and avoid the phenomenon of relapse in colon cancer patients with localized disease at the time of diagnosis. At the same time, it opens the door to the design of new diagnostic methods and treatments. There is still work to be done to understand what causes these cells with a high capacity for relapse, once they have traveled to the liver or lung, to become active and form metastases. We still need to understand how these cells originate, what determines their number and why their number varies between patients.  

This work reminds us that we are living in a decisive moment in oncology research in which technology and a level of knowledge are being achieved that allows us to confront many types of cancer. This work demonstrates, once again, that in Spain we have top-level researchers capable of making scientific advances of the highest level and impact if the necessary support is provided. The elaboration of a National Cancer Research Plan is urgent and cannot be postponed. Either we invest now or we will pay the consequences.