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The metastatic spread of cancer is achieved by the haematogenous dissemination of circulating tumour cells (CTCs). Generally, however, the temporal dynamics that dictate the generation of metastasis-competent CTCs are largely uncharacterized, and it is often assumed that CTCs are constantly shed from growing tumours or are shed as a consequence of mechanical insults1. Here the scientists observe a striking and unexpected pattern of CTC generation dynamics in both patients with breast cancer and mouse models, highlighting that most spontaneous CTC intravasation events occur during sleep. Further, they demonstrate that rest-phase CTCs are highly prone to metastasize, whereas CTCs generated during the active phase are devoid of metastatic ability. Mechanistically, single-cell RNA sequencing analysis of CTCs reveals a marked upregulation of mitotic genes exclusively during the rest phase in both patients and mouse models, enabling metastasis proficiency. Systemically, they find that key circadian rhythm hormones such as melatonin, testosterone and glucocorticoids dictate CTC generation dynamics, and as a consequence, that insulin directly promotes tumour cell proliferation in vivo, yet in a time-dependent manner. Thus, the spontaneous generation of CTCs with a high proclivity to metastasize does not occur continuously, but it is concentrated within the rest phase of the affected individual, providing a new rationale for time-controlled interrogation and treatment of metastasis-prone cancers. A study of patients with breast cancer and mouse models demonstrates that most circulating tumour cells are generated during the rest phase of the circadian rhythm, and that these cells are highly prone to metastasize.

The "auto exploration bra", developed by Julian Rios Cantu, contains 200 sensors that spot early signs of cancer.

He was inspired to invent it after his mother's breast cancer resulted in a double mastectomy after years battling the disease.

Brain metastases from breast cancer develop in patients with metastatic breast cancer. Current treatment options for brain metastases include surgery, radiation, chemotherapy and targeted therapies, but these have limited success and may worsen neurological function. Because 80% of women with brain metastases from breast cancer die within a year of diagnosis, Cittelly and her team want to find a way to target cancer cells after they have spread to the brain.

Working with cells in the lab, they have identified the interleukin 13 receptor alpha 2 (IL13Ra2) as a likely target for treatment. This is a protein that is found at increased levels in cancer cells that metastasize to other locations in the body, particularly the brain and lungs. In addition, the protein has shown vulnerability to treatment with CAR T cells in clinical trials of brain tumors. The researchers' next step is to initiate a collaboration with CAR T cell experts to better understand how CAR T cell therapy might target IL13Ra2.

Ultimately, Cittelly hopes to see clinical trials for patients with breast cancer that has metastasized to the brain, as they are currently excluded from clinical trials.