Cancer and Metastasis Reviews

, Volume 37, Issue 4, pp 655–663 | Cite as

Tackling tumor heterogeneity and phenotypic plasticity in cancer precision medicine: our experience and a literature review

  • Shijie ShengEmail author
  • M. Margarida Bernardo
  • Sijana H. Dzinic
  • Kang Chen
  • Elisabeth I. Heath
  • Wael A. Sakr


The predominant cause of cancer mortality is metastasis. The major impediment to cancer cure is the intrinsic or acquired resistance to currently available therapies. Cancer is heterogeneous at the genetic, epigenetic, and metabolic levels. And, while a molecular-targeted drug may be pathway-precise, it can still fail to achieve wholesome cancer-precise toxicity. In the current review, we discuss the strategic differences between targeting the strengths of cancer cells in phenotypic plasticity and heterogeneity and targeting shared vulnerabilities of cancer cells such as the compromised integrity of membranous organelles. To better recapitulate subpopulations of cancer cells in different phenotypic and functional states, we developed a schematic combination of 2-dimensional culture (2D), 3-dimmensional culture in collagen I (3D), and mammosphere culture for stem cells (mammosphere), designated as Scheme 2D/3D/mammosphere. We investigated how the tumor suppressor maspin may limit carcinoma cell plasticity and affect their context-dependent response to drugs of different mechanisms including docetaxel, histone deacetylase (HDAC) inhibitor MS-275, and ionophore antibiotic salinomycin. We showed that tumor cell phenotypic plasticity is not an exclusive attribute to cancer stem cells. Nonetheless, three subpopulations of prostate cancer cells, enriched through Scheme 2D/3D/mammosphere, show qualitatively different drug responses. Interestingly, salinomycin was the only drug that effectively killed all three cancer cell subpopulations, irrespective of their capacity of stemness. Further, Scheme 2D/3D/mammosphere may be a useful model to accelerate the screening for curative cancer drugs while avoiding costly characterization of compounds that may have only selective toxicity to some, but not all, cancer cell subpopulations.


Drug resistance Heterogeneity Cancer stem cells Proliferation Transient quiescence Epithelial-to-mesenchymal transition (EMT) Integrity of membranous subcellular structures Drug screening strategy Cell death Cell survival Cancer strength Cancer vulnerability Maspin Scheme 2D/3D/mammosphere Docetaxel MS-275 Salinomycin 


Financial support

This work was supported by the NIH Grant P30CA022453 (to the Karmanos Cancer Institute (KCI) with Sheng, S. as a program leader), the Ruth Sager Memorial Fund (to Sheng, S.), the KCI Pilot Project Grant 25S5Z (to Sheng, S.), the KCI Prostate Cancer Research Pilot Project Grant (to Sheng, S.), and the KCI Tumor Biology and Microenvironment Program Pilot Project (to Sheng, S).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Shijie Sheng
    • 1
    • 2
    • 3
    Email author
  • M. Margarida Bernardo
    • 1
    • 3
  • Sijana H. Dzinic
    • 2
    • 3
    • 4
  • Kang Chen
    • 2
    • 4
    • 5
  • Elisabeth I. Heath
    • 2
    • 4
  • Wael A. Sakr
    • 2
    • 3
  1. 1.Department of PathologyWayne State University School of MedicineDetroitUSA
  2. 2.Department of OncologyWayne State University School of MedicineDetroitUSA
  3. 3.Tumor Biology and Microenvironment ProgramWayne State University School of MedicineDetroitUSA
  4. 4.Molecular Therapeutics Program of the Barbara Ann Karmanos Cancer InstituteWayne State University School of MedicineDetroitUSA
  5. 5.Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitUSA

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