The metastatic process: history, models and recent advances

The onset of metastasis is a critical event in the natural history of cancer, and is generally associated with a poor clinical outcome. Mechanistically, the metastatic process is made of several steps that are biologically distinct and now rather well characterized. Several explanatory models have been proposed: selective models (clonal selection), adaptive models (initial oncogenesis), involvement of tumor "stem" cells, epithelial-mesenchymal transition… The next progresses are expected to come from the characterization of circulating and disseminated tumor cells, which are two recently opened windows on the metastatic process in patients.