Emerging paradigms in cancer cell plasticity

Cancer cells metastasize to distant organs by altering their characteristics within the tumor microenvironment (TME) to effectively overcome challenges during the multistep tumorigenesis. Plasticity endows cancer cell with the capacity to shift between different states to invade, disseminate, and seed metastasis. The epithelial-to-mesenchymal transition (EMT) is a cellular program that abrogates cell-cell adhesions by EMT transcription factors (TF) and acquires mesenchymal features during cancer progression. On the other hand, adherent-to-suspension transition (AST) is an emerging theory that describes the acquisition of hematopoietic features by AST-TFs that can induce the reprogramming of anchorage dependency and promote cancer cell dissemination. The induction and plasticity of EMT and AST dynamically reprogram cell-cell and cell-matrix interaction during cancer dissemination and colonization. Here, we review the mechanisms governing cellular plasticity of AST and EMT during the metastatic cascade and discuss therapeutic challenges posed by these two morphological adaptations to provide insights for establishing new therapeutic interventions.