Fig 8. Summary schematic of chemotherapy induced stromal injury and dormancy outgrowth.

This schematic shows a dormant tumor in the breast (on the left) with very few dormant cancer cells, healthy stromal cells, and an anti-tumor immune microenvironment. Chemotherapy injures stromal cells releasing IL-6 and G-CSF, which in turn awaken dormant cancer cells, recruit protumor neutrophils, and M2 macrophages. In addition, more protumor immune infiltrates such as Tregs and fewer anti-tumor CD8 T cells were seen after dormancy outgrowth, confirming an overall protumor microenvironment facilitating tumor growth. G-CSF, granulocyte colony stimulating factor.