“…Regardless of tumor type, once metastasis occurs and the primary tumor spreads to distant secondary sites, the 5-year survival rate of the patient dramatically decreases, emphasizing the need for early effective treatments and metastasis-specific therapies that prolong survival. 1 , 4 , 10 , 22 , 130 , 131 , 132 , 133 , 134 , 135 The cells of a tumor that metastasize to a secondary organ express a genetic profile that is different from the primary tumor, a characteristic of tumor heterogeneity that in some ways makes metastatic cancer its own distinct disease. 130 , 132 , 134 , 136 For example, several groups report specific secretome and genetic profiles of metastatic clones of cancer cell lines compared with the parental line, a biological trait that can be exploited by the engineering versatility of AAVs to specifically and effectively target subgroups of cancers located in either a primary or secondary site.…”