Cancer stem cell impact on clinical oncology

Abstract

Cancer is a widespread worldwide chronic disease. In most cases, the high mortality rate from cancer correlates with a lack of clear symptoms, which results in late diagnosis for patients, and consequently, advanced tumor disease with poor probabilities for cure, since many patients will show chemo- and radio-resistance. Several mechanisms have been studied to explain chemo- and radio-resistance to anti-tumor therapies, including cell signaling pathways, anti-apoptotic mechanisms, stemness, metabolism, and cellular phenotypes. Interestingly, the presence of cancer stem cells (CSCs), which are a subset of cells within the tumors, has been related to therapy resistance. In this review, we focus on evaluating the presence of CSCs in different tumors such as breast cancer, gastric cancer, lung cancer, and hematological neoplasias, highlighting studies where CSCs were identified in patient samples. It is evident that there has been a great drive to identify the cell surface phenotypes of CSCs so that they can be used as a tool for anti-tumor therapy treatment design. We also review the potential effect of nanoparticles, drugs, natural compounds, aldehyde dehydrogenase inhibitors, cell signaling inhibitors, and antibodies to treat CSCs from specific tumors. Taken together, we present an overview of the role of CSCs in tumorigenesis and how research is advancing to target these highly tumorigenic cells to improve oncology patient outcomes.

Keywords: Cancer; Targeted therapy; Clinical outcome; Drug resistance; Cancer stem cells

Core tip: Tumor heterogeneity can explain the presence of cells that display high tumorigenic capacity along with chemo- and radio-resistance properties. These cells, identified as cancer stem cells (CSCs), are partially responsible for recurrence and tumor progression. Most tumors follow the CSC model, which indicates the existence of a subset of highly tumorigenic cells. This has been shown to be the case for several patients with several types of tumors. In this review, we focus on the phenotypes used for the study and identification of CSCs from human samples, as well as promising strategies to target CSCs.