Tumor cell plasticity in non-small cell lung cancer: the role of microRNA and implications for diagnosis, prognosis and treatment

Lung cancer is one of the leading causes of cancer morbidity and mortality worldwide. Majority of cases are diagnosed as late-stage disease. Non-small cell lung cancer (NSCLC) forms the major pathologic group of this disease. The high malignantly nature of NSCLC is mediated by tumor cell plasticity (TCP). Designated as a hallmark of cancer, it is the ability of cancer cells to reprogram its molecular cell state and behaviour in response to environmental stress. MicroRNAs (miRNA) play a major role in TCP of NSCLC from premalignant disease, tumor initiation, progression and invasion, immune evasion to metastasis. TCP mediated by miRNA include epithelial mesenchymal transition, cancer stem cell biology, and cross talk between cancer and its tumor microenvironment. An understanding of these mechanisms gives a more comprehensive and precise molecular profile of NSCLC behaviour and implications for diagnosis, prognosis, monitoring and treatment. Emerging technologies including liquid biopsy, tumor geospatial profiling and single cell RNA sequencing hold promise to transform the clinical management of NSCLC.