  In this review, we discuss recent advances on the plasticity of cancer stem
cells and highlight their relevance to understand the metastatic process and to
guide therapeutic interventions. Recent results suggest that the strict
hierarchical structure of cancer cell populations advocated by the cancer stem
cell model must be reconsidered since the depletion of cancer stem cells leads
the other tumor cells to switch back into the cancer stem cell phenotype. This
plasticity has important implications for metastasis since migrating cells do
not need to be cancer stem cells in order to seed a metastasis. We also discuss
the important role of the immune system and the microenvironment in modulating
phenotypic switching and suggest possible avenues to exploit our understanding
of this process to develop an effective strategy for precision medicine.
