Metabolic plasticity is a hallmark of cancer, enabling tumour cells to grow and adapt to microenvironmental stress, eventually contributing to tumour heterogeneity. Although glycolysis-oxidative phosphorylation (OXPHOS) switch plays a pivotal role, emerging evidence highlights OXPHOS as an essential mechanism for cancer survival, particularly during metastasis and therapeutic stress, underscoring the complexities underlying metabolic plasticity and tumour heterogeneity. The role of glycolysis-OXPHOS switch in cancer stem cells (CSCs), a highly aggressive and drug-resistant population frequently enriched in response to the stress of tumour growth and pressure from microenvironmental or therapeutic cues, remains an open question with therapeutic interventions yielding mixed outcomes. While some strategies suppress CSC activity, others inadvertently promote resistance and tumour aggressiveness, thus contributing to treatment failure and relapse. This review critically examines the role of glycolysis-OXPHOS switch as a gatekeeper of tumorigenesis which influences CSC plasticity and resistance. By dissecting these metabolic dynamics, it aims to inform novel therapeutic strategies, emphasising tailored approaches to target CSC plasticity and improve cancer treatment outcomes.
Keoh et al. (2025) studied this question.