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Ntzifa A, Lianidou E. Pre-analytical conditions and implementation of quality control steps in liquid biopsy analysis. Crit Rev Clin Lab Sci 2023; 60:573-594. [PMID: 37518938 DOI: 10.1080/10408363.2023.2230290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
Over the last decade, great advancements have been made in the field of liquid biopsy through extensive research and the development of new technologies that facilitate the use of liquid biopsy for cancer patients. This is shown by the numerous liquid biopsy tests that gained clearance by the US Food and Drug Administration (FDA) in recent years. Liquid biopsy has significantly altered cancer treatment by providing clinicians with powerful and immediate information about therapeutic decisions. However, the clinical integration of liquid biopsy is still challenging and there are many critical factors to consider prior to its implementation into routine clinical practice. Lack of standardization due to technical challenges and the definition of the clinical utility of specific assays further complicates the establishment of Standard Operating Procedures (SOPs) in liquid biopsy. Harmonization of laboratories to established guidelines is of major importance to overcome inter-lab variabilities observed. Quality control assessment in diagnostic laboratories that offer liquid biopsy testing will ensure that clinicians can base their therapeutic decisions on robust results. The regular participation of laboratories in external quality assessment schemes for liquid biopsy testing aims to promptly pinpoint deficiencies and efficiently educate laboratories to improve their quality of services. Accreditation of liquid biopsy diagnostic laboratories based on the ISO15189 standard in Europe or by CLIA/CAP accreditation procedures in the US is the best way to achieve the adaptation of liquid biopsy into the clinical setting by assuring reliable results for the clinicians and their cancer patients. Nowadays, various organizations from academia, industry, and regulatory agencies collaborate to set a framework that will include all procedures from the pre-analytical phase and the analytical process to the final interpretation of results. In this review, we underline several challenges in the analysis of circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) concerning standardization of protocols, quality control assessment, harmonization of laboratories, and compliance to specific guidelines that need to be thoroughly considered before liquid biopsy enters the clinic.
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Affiliation(s)
- Aliki Ntzifa
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Evi Lianidou
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece
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Jiang W, Han L, Li G, Yang Y, Shen Q, Fan B, Wang Y, Yu X, Sun Y, He S, Du H, Miao J, Wang Y, Jia L. Baits-trap chip for accurate and ultrasensitive capture of living circulating tumor cells. Acta Biomater 2023; 162:226-239. [PMID: 36940769 DOI: 10.1016/j.actbio.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 03/22/2023]
Abstract
Accurate analysis of living circulating tumor cells (CTCs) plays a crucial role in cancer diagnosis and prognosis evaluation. However, it is still challenging to develop a facile method for accurate, sensitive, and broad-spectrum isolation of living CTCs. Herein, inspired by the filopodia-extending behavior and clustered surface-biomarker of living CTCs, we present a unique baits-trap chip to achieve accurate and ultrasensitive capture of living CTCs from peripheral blood. The baits-trap chip is designed with the integration of nanocage (NCage) structure and branched aptamers. The NCage structure could "trap" the extended filopodia of living CTCs and resist the adhesion of filopodia-inhibited apoptotic cells, thus realizing the accurate capture (∼95% accuracy) of living CTCs independent of complex instruments. Using an in-situ rolling circle amplification (RCA) method, branched aptamers were easily modified onto the NCage structure, and served as "baits" to enhance the multi-interactions between CTC biomarker and chips, leading to ultrasensitive (99%) and reversible cell capture performance. The baits-trap chip successfully detects living CTCs in broad-spectrum cancer patients and achieves high diagnostic sensitivity (100%) and specificity (86%) of early prostate cancer. Therefore, our baits-trap chip provides a facile, accurate, and ultrasensitive strategy for living CTC isolation in clinical. STATEMENT OF SIGNIFICANCE: A unique baits-trap chip integrated with precise nanocage structure and branched aptamers was developed for the accurate and ultrasensitive capture of living CTCs. Compared with the current CTC isolation methods that are unable to distinguish CTC viability, the nanocage structure could not only "trap" the extended-filopodia of living CTCs, but also resist the adhesion of filopodia-inhibited apoptotic cells, thus realizing the accurate capture of living CTCs. Additionally, benefiting from the "baits-trap" synergistic effects generated by aptamer modification and nanocage structure, our chip achieved ultrasensitive, reversible capture of living CTCs. Moreover, this work provided a facile strategy for living CTC isolation from the blood of patients with early-stage and advanced cancer, exhibiting high consistency with the pathological diagnosis.
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Affiliation(s)
- Wenning Jiang
- Liaoning Key Laboratory of Molecular Recognition and Imaging, School of Bioengineering, Dalian University of Technology, Dalian 116023, P. R. China
| | - Lulu Han
- Liaoning Key Laboratory of Molecular Recognition and Imaging, School of Bioengineering, Dalian University of Technology, Dalian 116023, P. R. China.
| | - Guorui Li
- Liaoning Key Laboratory of Molecular Recognition and Imaging, School of Bioengineering, Dalian University of Technology, Dalian 116023, P. R. China
| | - Ying Yang
- Liaoning Key Laboratory of Molecular Recognition and Imaging, School of Bioengineering, Dalian University of Technology, Dalian 116023, P. R. China
| | - Qidong Shen
- Liaoning Key Laboratory of Molecular Recognition and Imaging, School of Bioengineering, Dalian University of Technology, Dalian 116023, P. R. China
| | - Bo Fan
- Department of Urology, The Second Hospital Affiliated of Dalian Medical University, Dalian 116023, P. R. China
| | - Yuchao Wang
- Department of Urology, The Second Hospital Affiliated of Dalian Medical University, Dalian 116023, P. R. China
| | - Xiaomin Yu
- Department of Oncology, The Dalian Municipal Central Hospital Affiliated of Dalian University of Technology, Dalian 116033, P.R. China
| | - Yan Sun
- Department of Oncology, The Dalian Municipal Central Hospital Affiliated of Dalian University of Technology, Dalian 116033, P.R. China
| | - Shengxiu He
- Department of Oncology, The Dalian Municipal Central Hospital Affiliated of Dalian University of Technology, Dalian 116033, P.R. China
| | - Huakun Du
- Department of Oncology, The Dalian Municipal Central Hospital Affiliated of Dalian University of Technology, Dalian 116033, P.R. China
| | - Jian Miao
- Hepatobiliary Pancreatic Surgery II, The Second Hospital Affiliated of Dalian Medical University, Dalian 116023, P. R. China
| | - Yuefeng Wang
- Hepatobiliary Pancreatic Surgery II, The Second Hospital Affiliated of Dalian Medical University, Dalian 116023, P. R. China
| | - Lingyun Jia
- Liaoning Key Laboratory of Molecular Recognition and Imaging, School of Bioengineering, Dalian University of Technology, Dalian 116023, P. R. China.
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Liquid Biopsy as a Tool for the Diagnosis, Treatment, and Monitoring of Breast Cancer. Int J Mol Sci 2022; 23:ijms23179952. [PMID: 36077348 PMCID: PMC9456236 DOI: 10.3390/ijms23179952] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer (BC) is a highly heterogeneous disease. The treatment of BC is complicated owing to intratumoral complexity. Tissue biopsy and immunohistochemistry are the current gold standard techniques to guide breast cancer therapy; however, these techniques do not assess tumoral molecular heterogeneity. Personalized medicine aims to overcome these biological and clinical complexities. Advances in techniques and computational analyses have enabled increasingly sensitive, specific, and accurate application of liquid biopsy. Such progress has ushered in a new era in precision medicine, where the objective is personalized treatment of breast cancer, early screening, accurate diagnosis and prognosis, relapse detection, longitudinal monitoring, and drug selection. Liquid biopsy can be defined as the sampling of components of tumor cells that are released from a tumor and/or metastatic deposits into the blood, urine, feces, saliva, and other biological substances. Such components include circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) or circulating tumor RNA (ctRNA), platelets, and exosomes. This review aims to highlight the role of liquid biopsy in breast cancer and precision medicine.
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Coagulation/fibrinolysis and circulating tumor cells in patients with advanced breast cancer. Breast Cancer Res Treat 2022; 192:583-591. [PMID: 35132503 PMCID: PMC8960658 DOI: 10.1007/s10549-021-06484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
Abstract
Purpose To evaluate the relationship between circulating tumor cells (CTCs) and standard coagulation tests in both a discovery and a validation cohort of patients with advanced breast cancer. Methods In a retrospective (n = 77) and a prospective (n = 92) study of patients with progressive advanced breast cancer, CTC count, platelet number, fibrinogen level, D-dimers, prothrombin time, and activated partial thromboplastin time were measured. The association between these coagulation studies and CTC count was analyzed. The impact of these measurements on overall survival (OS) was assessed. Results In both cohorts, results were similar; absolute CTC count was significantly associated to D-dimer level and inversely with platelet count. In the prospective cohort, quantification of tumor-derived extracellular vesicles (tdEVs) was associated with CTC count, and with coagulation abnormalities (low platelet count and increased D-dimers). tdEVs did not add to CTC count in predicting changes in platelets or D-dimers. In multivariate analysis only CTC ≥ 5 CTC/7.5 mL, ER status, HER2 status and lines of chemotherapy were associated with OS. In patients with terminally metastatic breast cancer, very high CTC counts are prevalent. Conclusion A significant association exists between increasing CTC number and increased D-dimers and decreased platelet counts, suggesting a potential role for CTCs as a direct contributor of intravascular coagulation activation. In patients with advanced and progressive breast cancer, abnormalities in routine coagulation tests is the rule. In patients with terminally advanced breast cancer a “leukemic” phase with high CTC count is prevalent.
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Foy V, Lindsay CR, Carmel A, Fernandez-Gutierrez F, Krebs MG, Priest L, Carter M, Groen HJM, Hiltermann TJN, de Luca A, Farace F, Besse B, Terstappen L, Rossi E, Morabito A, Perrone F, Renehan A, Faivre-Finn C, Normanno N, Dive C, Blackhall F, Michiels S. EPAC-lung: European pooled analysis of the prognostic value of circulating tumour cells in small cell lung cancer. Transl Lung Cancer Res 2021; 10:1653-1665. [PMID: 34012782 PMCID: PMC8107738 DOI: 10.21037/tlcr-20-1061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Circulating tumour cell (CTC) number is an independent prognostic factor in patients with small cell lung cancer (SCLC) but there is no consensus on the CTC threshold for prognostic significance. We undertook a pooled analysis of individual patient data to clinically validate CTC enumeration and threshold for prognostication. METHODS Four European cancer centres, experienced in CellSearch CTC enumeration for SCLC provided pseudo anonymised data for patients who had undergone pre-treatment CTC count. Data was collated, and Cox regression models, stratified by centre, explored the relationship between CTC count and survival. The added value of incorporating CTCs into clinico-pathological models was investigated using likelihood ratio tests. RESULTS A total of 367 patient records were evaluated. A one-unit increase in log-transformed CTC counts corresponded to an estimated hazard ratio (HR) of 1.24 (95% CI: 1.19-1.29, P<0.0001) for progression free survival (PFS) and 1.23 (95% CI: 1.18-1.28, P<0.0001) for overall survival (OS). CTC count of ≥15 or ≥50 was significantly associated with an increased risk of progression (CTC ≥15: HR 3.20, 95% CI: 2.50-4.09, P<0.001; CTC ≥50: HR 2.56, 95% CI: 2.01-3.25, P<0.001) and an increased risk of death (CTC ≥15: HR 2.90, 95% CI: 2.28-3.70, P<0.001; CTC ≥50: HR 2.47, 95% CI: 1.95-3.13, P<0.001). There was no significant inter-centre heterogeneity observed. Addition of CTC count to clinico-pathological models as a continuous log-transformed variable, offers further prognostic value (both likelihood ratio P<0.001 for OS and PFS). CONCLUSIONS Higher pre-treatment CTC counts are a negative independent prognostic factor in SCLC when considered as a continuous variable or dichotomised counts of ≥15 or ≥50. Incorporating CTC counts, as a continuous variable, improves clinic-pathological prognostic models.
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Affiliation(s)
- Victoria Foy
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Colin R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - Alexandra Carmel
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U1018 OncoStat, CESP, Université Paris-Sud, Université Paris-Saclay, labeled by Ligue Contre le Cancer, France
| | - Fabiola Fernandez-Gutierrez
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - Matthew G Krebs
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - Lynsey Priest
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mathew Carter
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - T Jeroen N Hiltermann
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Antonella de Luca
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Francoise Farace
- INSERM, U981 "Predictive Biomarkers and New Therapeutics in Oncology", F-94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay. "Rare Circulating Cells" Translational Platform, CNRS UMS3655 - INSERM US23, AMMICA, Villejuif, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France; Paris-Sud University, Orsay, France
| | - Leon Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Elisabetta Rossi
- Department of Surgery, Oncology and Gastroenterology, Oncology Section, University of Padova, Padova, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Andrew Renehan
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Corinne Faivre-Finn
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Caroline Dive
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - Stefan Michiels
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U1018 OncoStat, CESP, Université Paris-Sud, Université Paris-Saclay, labeled by Ligue Contre le Cancer, France
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Abstract
Cancer is a heterogeneous disease that requires a multimodal approach to diagnose, manage and treat. A better understanding of the disease biology can lead to identification of novel diagnostic/prognostic biomarkers and the discovery of the novel therapeutics with the goal of improving patient outcomes. Employing advanced technologies can facilitate this, enabling better diagnostic and treatment for cancer patients. In this regard, microfluidic technology has emerged as a promising tool in the studies of cancer, including single cancer cell analysis, modeling angiogenesis and metastasis, drug screening and liquid biopsy. Microfluidic technologies have opened new ways to study tumors in the preclinical and clinical settings. In this chapter, we highlight novel application of this technology in area of fundamental, translational and clinical cancer research.
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de Kruijff IE, Beije N, Martens JWM, de Wit R, Boormans JL, Sleijfer S. Liquid Biopsies to Select Patients for Perioperative Chemotherapy in Muscle-invasive Bladder Cancer: A Systematic Review. Eur Urol Oncol 2020; 4:204-214. [PMID: 32059957 DOI: 10.1016/j.euo.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/12/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Neoadjuvant chemotherapy (NAC) is considered the standard treatment for muscle-invasive bladder cancer (MIBC). However, its overall survival benefit is limited and toxicity is significant; hence, NAC has not been adopted universally. OBJECTIVE To systematically evaluate whether biomarkers can guide the administration of perioperative chemotherapy in MIBC patients. EVIDENCE ACQUISITION A systematic search of the PubMed database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). In total, 215 papers were screened and 22 were selected to assess the potential clinical value of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) in selecting MIBC patients for perioperative chemotherapy. EVIDENCE SYNTHESIS We found that the presence of one or more CTCs before radical cystectomy, as determined by the CellSearch technique, is a robust marker for poor recurrence-free and overall survival. Consequently, whether NAC can be withheld in patients without the presence of CTCs is a subject of ongoing investigation. Studies investigating various approaches to detect cfDNA showed that cfDNA is present in the blood of MIBC patients, but varying results on its prognostic value have been reported. Successful cfDNA-based approaches are likely to encompass at least a multitude of genes using next-generation sequencing, as there are generally few hotspot somatic mutations in MIBC. CONCLUSIONS Liquid biopsies hold promise in selecting MIBC patients for perioperative chemotherapy, but instead of more proof-of-principle studies, prospective studies investigating true clinical applicability for treatment decision making are urgently needed. PATIENT SUMMARY Liquid biopsies appear to be a promising tool to guide the administration of chemotherapy in patients with muscle-invasive bladder cancer; however, the optimal way to implement these remains to be determined.
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Affiliation(s)
- Ingeborg E de Kruijff
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nick Beije
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John W M Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ronald de Wit
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zeune LL, Boink YE, van Dalum G, Nanou A, de Wit S, Andree KC, Swennenhuis JF, van Gils SA, Terstappen LW, Brune C. Deep learning of circulating tumour cells. NAT MACH INTELL 2020. [DOI: 10.1038/s42256-020-0153-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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van Bussel MTJ, Pluim D, Milojkovic Kerklaan B, Bol M, Sikorska K, Linders DTC, van den Broek D, Beijnen JH, Schellens JHM, Brandsma D. Circulating epithelial tumor cell analysis in CSF in patients with leptomeningeal metastases. Neurology 2020; 94:e521-e528. [PMID: 31907288 DOI: 10.1212/wnl.0000000000008751] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The primary objective was to determine the sensitivity and specificity of epithelial cell adhesion molecule (EpCAM) immunoflow cytometry circulating tumor cells (CTC) analysis in CSF in patients with suspected leptomeningeal metastases (LM). The secondary objective was to explore the distribution of driver mutations in the primary tumor, plasma, cell free CSF (cfCSF), and isolated CTC from CSF in non-small cell lung cancer (NSCLC). METHODS We tested the performance of the CTC assay vs CSF cytology in a prospective study in 81 patients with a clinical suspicion of LM but a nonconfirmatory MRI. In an NSCLC subcohort, we analyzed circulating tumor (ct)DNA of the selected driver mutations by digital droplet PCR (ddPCR). RESULTS The sensitivity of the CTC assay was 94% (95% confidence interval [CI] 80-99) and the specificity was 100% (95% CI 91-100) at the optimal cutoff of 0.9 CTC/mL. The sensitivity of cytology was 76% (95% CI 58-89). Twelve of the 23 patients with NSCLC had mutated epidermal growth factor receptor (EGFR). All 5 tested patients with LM demonstrated the primary EGFR driver mutation in cfCSF. The driver mutation could also be detected in CTC isolated from CSF. CONCLUSION CTC in CSF are detected with a high sensitivity for the diagnosis of LM. ddPCR can determine EGFR mutations in both cfCSF and isolated CTC from CSF of patients with EGFR-mutated NSCLC and LM. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EpCAM-based immunoflow cytometry analysis of CSF accurately identifies patients with LM.
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Affiliation(s)
- Mark T J van Bussel
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dick Pluim
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Bojana Milojkovic Kerklaan
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Mijke Bol
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Karolina Sikorska
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dorothé T C Linders
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Daan van den Broek
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Jos H Beijnen
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Jan H M Schellens
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Dieta Brandsma
- From the Division of Pharmacology (M.T.J.v.B., D.P., B.M.K., J.H.B., J.H.M.S.), Clinical Pharmacology (M.T.J.v.B., B.M.K., J.H.B., J.H.M.S), Division of Pathology (M.B.), Department of Biometrics (K.S.), Department of Laboratory Medicine (D.T.C.L., D.v.d.B.), and Department of Neuro-oncology (D.B.), Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; and Science Faculty (J.H.B., J.H.M.S), Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, the Netherlands.
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10
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Martos T, Casadevall D, Albanell J. Circulating Tumor Cells: Applications for Early Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1220:135-146. [PMID: 32304084 DOI: 10.1007/978-3-030-35805-1_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Breast cancer is the most common malignancy among women. Most of breast cancer patients are diagnosed in early stages and will be treated with curative intent. Despite this, some patients will relapse. The identification of patients at high risk remains an important challenge. CTCs can be useful to identify this patients, to assess tumor dynamics and to monitoring therapy. There is definitive evidence on the prognostic role of CTCs in early breast cancer (eBC) but its clinical utility in daily practice is still lacking. We have to take into consideration that the studies published to date mainly evaluated the presence of CTC based on the expression of epithelial surface markers. Future studies need to overcome this limitation and important advances in technical methods can assess CTCs and capture the heterogeneity of the tumor landscape. It is also tempting to speculate that CTCs may also provide complementary information on the interplay of tumor cells with the immune system. The combination of different methods to detect tumoral disease by liquid biopsy may provide new ways to personalize in an unprecedented manner the management of patients with eBC.
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Affiliation(s)
- Tamara Martos
- Servei d'Oncologia Mèdica, Hospital del Mar, Barcelona, Spain
| | - David Casadevall
- Servei d'Oncologia Mèdica, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Joan Albanell
- Servei d'Oncologia Mèdica, Hospital del Mar, Barcelona, Spain. .,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,CEXS Department, Pompeu Fabra University, Barcelona, Spain. .,CIOCC HM Delfos, Barcelona, Spain.
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11
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Temilola DO, Wium M, Coulidiati TH, Adeola HA, Carbone GM, Catapano CV, Zerbini LF. The Prospect and Challenges to the Flow of Liquid Biopsy in Africa. Cells 2019; 8:E862. [PMID: 31404988 PMCID: PMC6721679 DOI: 10.3390/cells8080862] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 12/24/2022] Open
Abstract
Liquid biopsy technologies have the potential to transform cancer patient management as it offers non-invasive diagnosis and real-time monitoring of disease progression and treatment responses. The use of liquid biopsy for non-invasive cancer diagnosis can have pivotal importance for the African continent where access to medical infrastructures is limited, as it eliminates the need for surgical biopsies. To apply liquid biopsy technologies in the African setting, the influence of environmental and population genetic factors must be known. In this review, we discuss the use of circulating tumor cells, cell-free nucleic acids, extracellular vesicles, protein, and other biomolecules in liquid biopsy technology for cancer management with special focus on African studies. We discussed the prospect, barriers, and other aspects that pose challenges to the use of liquid biopsy in the African continent.
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Affiliation(s)
- Dada Oluwaseyi Temilola
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town 7925, South Africa
- Integrative Biomedical Sciences Division, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Martha Wium
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town 7925, South Africa
| | - Tangbadioa Herve Coulidiati
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town 7925, South Africa
- Training and Research unit in Sciences and Technology, University Norbert Zongo, P.O. Box 376, Koudougou 376, Burkina Faso
| | - Henry Ademola Adeola
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
| | - Giuseppina Maria Carbone
- Institute of Oncology Research, Università della Svizzera Italiana, Via Vincenzo Vela 6, CH-6500 Bellinzona, Switzerland
| | - Carlo Vittorio Catapano
- Institute of Oncology Research, Università della Svizzera Italiana, Via Vincenzo Vela 6, CH-6500 Bellinzona, Switzerland
| | - Luiz Fernando Zerbini
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town 7925, South Africa.
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12
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Raillon C, Che J, Thill S, Duchamp M, Desbiolles BXE, Millet A, Sollier E, Renaud P. Toward Microfluidic Label-Free Isolation and Enumeration of Circulating Tumor Cells from Blood Samples. Cytometry A 2019; 95:1085-1095. [PMID: 31364817 DOI: 10.1002/cyto.a.23868] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022]
Abstract
The isolation, analysis, and enumeration of circulating tumor cells (CTCs) from cancer patient blood samples are a paradigm shift for cancer patient diagnosis, prognosis, and treatment monitoring. Most methods used to isolate and enumerate these target cells rely on the expression of cell surface markers, which varies between patients, cancer types, tumors, and stages. Here, we propose a label-free high-throughput platform to isolate, enumerate, and size CTCs on two coupled microfluidic devices. Cancer cells were purified through a Vortex chip and subsequently flowed in-line to an impedance chip, where a pair of electrodes measured fluctuations of an applied electric field generated by cells passing through. A proof-of-concept of the coupling of those two devices was demonstrated with beads and cells. First, the impedance chip was tested as a stand-alone device: (1) with beads (mean counting error of 1.0%, sizing information clearly separated three clusters for 8, 15, and 20 um beads, respectively) as well as (2) with cancer cells (mean counting error of 3.5%). Second, the combined setup was tested with beads, then with cells in phosphate-buffered saline, and finally with cancer cells spiked in healthy blood. Experiments demonstrated that the Vortex HT chip enriched the cancer cells, which then could be counted and differentiated from smaller blood cells by the impedance chip based on size information. Further discrimination was shown with dual high-frequency measurements using electric opacity, highlighting the potential application of this combined setup for a fully integrated label-free isolation and enumeration of CTCs from cancer patient samples. © 2019 International Society for Advancement of Cytometry.
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Affiliation(s)
- Camille Raillon
- STI-IMT-LMIS4, EPFL, 1015, Lausanne, Switzerland.,Vortex Biosciences, Inc., Pleasanton, California, 94588
| | - James Che
- Vortex Biosciences, Inc., Pleasanton, California, 94588
| | - Sandy Thill
- STI-IMT-LMIS4, EPFL, 1015, Lausanne, Switzerland
| | | | | | - Arnaud Millet
- Team Mechanobiology, Immunity and Cancer, Institute for Advanced Biosciences, INSERM U1209 CNRS UMR5309, Grenoble, France.,Grenoble Alpes University, Grenoble, France
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13
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Tay RY, Fernández-Gutiérrez F, Foy V, Burns K, Pierce J, Morris K, Priest L, Tugwood J, Ashcroft L, Lindsay CR, Faivre-Finn C, Dive C, Blackhall F. Prognostic value of circulating tumour cells in limited-stage small-cell lung cancer: analysis of the concurrent once-daily versus twice-daily radiotherapy (CONVERT) randomised controlled trial. Ann Oncol 2019; 30:1114-1120. [PMID: 31020334 PMCID: PMC6637373 DOI: 10.1093/annonc/mdz122] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical significance of circulating tumour cells (CTCs) in limited-stage small-cell lung cancer (LS-SCLC) is not well defined. We report a planned exploratory analysis of the prevalence and prognostic value of CTCs in LS-SCLC patients enrolled within the phase III randomised CONVERT (concurrent once-daily versus twice-daily chemoradiotherapy) trial. PATIENTS AND METHODS Baseline blood samples were enumerated for CTCs using CellSearch in 75 patients with LS-SCLC who were enrolled in the CONVERT trial and randomised between twice- and once-daily concurrent chemoradiation. Standard statistical methods were used for correlations of CTCs with clinical factors. Log-rank test and Cox regression analyses were applied to establish the associations of 2, 15 and 50 CTC thresholds with progression-free survival (PFS) and overall survival (OS). An optimal CTC count threshold for LS-SCLC was established. RESULTS CTCs were detected in 60% (45/75) of patients (range 0-3750). CTC count thresholds of 2, 15 and 50 CTCs all significantly correlate with PFS and OS. An optimal CTC count threshold in LS-SCLC was established at 15 CTCs, defining 'favourable' and 'unfavourable' prognostic risk groups. The median OS in <15 versus ≥15 CTCs was 26.7 versus 5.9 m (P = 0.001). The presence of ≥15 CTCs at baseline independently predicted ≤1 year survival in 70% and ≤2 years survival in 100% of patients. CONCLUSION We report the prognostic value of baseline CTC count in an exclusive LS-SCLC population at thresholds of 2, 15 and 50 CTCs. Specific to LS-SCLC, ≥15 CTCs was associated with worse PFS and OS independent of all other factors and predicted ≤2 years survival. These results may improve disease stratification in future clinical trial designs and aid clinical decision making. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00433563.
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Affiliation(s)
- R Y Tay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester
| | | | - V Foy
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - K Burns
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health
| | - J Pierce
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - K Morris
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - L Priest
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - J Tugwood
- Cancer Research UK Manchester Institute; Manchester Centre for Cancer Biomarker Sciences, University of Manchester, Manchester
| | - L Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit
| | - C R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health
| | - C Faivre-Finn
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health; Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - C Dive
- Cancer Research UK Manchester Institute; Manchester Centre for Cancer Biomarker Sciences, University of Manchester, Manchester
| | - F Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health.
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14
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Boire A, Brandsma D, Brastianos PK, Le Rhun E, Ahluwalia M, Junck L, Glantz M, Groves MD, Lee EQ, Lin N, Raizer J, Rudà R, Weller M, Van den Bent MJ, Vogelbaum MA, Chang S, Wen PY, Soffietti R. Liquid biopsy in central nervous system metastases: a RANO review and proposals for clinical applications. Neuro Oncol 2019; 21:571-584. [PMID: 30668804 PMCID: PMC6502489 DOI: 10.1093/neuonc/noz012] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liquid biopsies collect and analyze tumor components in body fluids, and there is an increasing interest in the investigation of liquid biopsies as a surrogate for tumor tissue in the management of both primary and secondary brain tumors. Herein we critically review available literature on spinal fluid and plasma circulating tumor cells (CTCs) and cell-free tumor (ctDNA) for diagnosis and monitoring of leptomeningeal and parenchymal brain metastases. We discuss technical issues and propose several potential applications of liquid biopsies in different clinical settings (ie, for initial diagnosis, for assessment during treatment, and for guidance of treatment decisions). Last, ongoing clinical studies on CNS metastases that include liquid biopsies are summarized, and recommendations for future clinical studies are provided.
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Affiliation(s)
- Adrienne Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute‒Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Priscilla K Brastianos
- Departments of Medicine and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emilie Le Rhun
- Department of Neuro-Oncology/Neurosurgery, University Hospital, Lille, France
| | - Manmeet Ahluwalia
- Department of Medicine, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Glantz
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA
| | - Morris D Groves
- Department of Neuro-Oncology, Austin Brain Tumor Center and University of Texas, Austin, Texas, USA
| | - Eudocia Q Lee
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Raizer
- Department of Neurology and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, University Hospital, Zurich, Switzerland
| | | | - Michael A Vogelbaum
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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15
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Breuninger S, Stangl S, Werner C, Sievert W, Lobinger D, Foulds GA, Wagner S, Pickhard A, Piontek G, Kokowski K, Pockley AG, Multhoff G. Membrane Hsp70-A Novel Target for the Isolation of Circulating Tumor Cells After Epithelial-to-Mesenchymal Transition. Front Oncol 2018; 8:497. [PMID: 30443493 PMCID: PMC6223102 DOI: 10.3389/fonc.2018.00497] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/12/2018] [Indexed: 12/29/2022] Open
Abstract
The presence of circulating tumor cells (CTCs) in the peripheral blood is a pre-requisite for progression, invasion, and metastatic spread of cancer. Consequently, the enumeration and molecular characterization of CTCs from the peripheral blood of patients with solid tumors before, during and after treatment serves as a valuable tool for categorizing disease, evaluating prognosis and for predicting and monitoring therapeutic responsiveness. Many of the techniques for isolating CTCs are based on the expression of epithelial cell surface adhesion molecule (EpCAM, CD326) on tumor cells. However, the transition of adherent epithelial cells to migratory mesenchymal cells (epithelial-to-mesenchymal transition, EMT)-an essential element of the metastatic process-is frequently associated with a loss of expression of epithelial cell markers, including EpCAM. A highly relevant proportion of mesenchymal CTCs cannot therefore be isolated using techniques that are based on the "capture" of cells expressing EpCAM. Herein, we provide evidence that a monoclonal antibody (mAb) directed against a membrane-bound form of Hsp70 (mHsp70)-cmHsp70.1-can be used for the isolation of viable CTCs from peripheral blood of tumor patients of different entities in a more quantitative manner. In contrast to EpCAM, the expression of mHsp70 remains stably upregulated on migratory, mesenchymal CTCs, metastases and cells that have been triggered to undergo EMT. Therefore, we propose that approaches for isolating CTCs based on the capture of cells that express mHsp70 using the cmHsp70.1 mAb are superior to those based on EpCAM expression.
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Affiliation(s)
- Stephanie Breuninger
- Center for Translational Cancer Research TU München (TranslaTUM), Klinikum rechts der Isar, TUM, Munich, Germany
| | - Stefan Stangl
- Center for Translational Cancer Research TU München (TranslaTUM), Klinikum rechts der Isar, TUM, Munich, Germany
| | - Caroline Werner
- Center for Translational Cancer Research TU München (TranslaTUM), Klinikum rechts der Isar, TUM, Munich, Germany
| | - Wolfgang Sievert
- Center for Translational Cancer Research TU München (TranslaTUM), Klinikum rechts der Isar, TUM, Munich, Germany
| | - Dominik Lobinger
- Center for Translational Cancer Research TU München (TranslaTUM), Klinikum rechts der Isar, TUM, Munich, Germany
| | - Gemma A Foulds
- John van Geest Cancer Research Centre, College of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Sarah Wagner
- John van Geest Cancer Research Centre, College of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Anja Pickhard
- Department of Otolaryngology Head and Neck Surgery, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Guido Piontek
- Department of Otolaryngology Head and Neck Surgery, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Konrad Kokowski
- Department of Pneumology and Pneumologic Oncology, Klinikum Bogenhausen, Munich, Germany
| | - Alan G Pockley
- John van Geest Cancer Research Centre, College of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Gabriele Multhoff
- Center for Translational Cancer Research TU München (TranslaTUM), Klinikum rechts der Isar, TUM, Munich, Germany
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16
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Zeune LL, de Wit S, Berghuis AMS, IJzerman MJ, Terstappen LWMM, Brune C. How to Agree on a CTC: Evaluating the Consensus in Circulating Tumor Cell Scoring. Cytometry A 2018; 93:1202-1206. [PMID: 30246927 PMCID: PMC6585854 DOI: 10.1002/cyto.a.23576] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/18/2022]
Abstract
For using counts of circulating tumor cells (CTCs) in the clinic to aid a physician's decision, its reported values will need to be accurate and comparable between institutions. Many technologies have become available to enumerate and characterize CTCs, thereby showing a large range of reported values. Here we introduce an Open Source CTC scoring tool to enable comparison of different reviewers and facilitate the reach of a consensus on assigning objects as CTCs. One hundred images generated from two different platforms were used to assess concordance between 15 reviewers and an expert panel. Large differences were observed between reviewers in assigning objects as CTCs urging the need for computer recognition of CTCs. A demonstration of a deep learning approach on the 100 images showed the promise of this technique for future CTC enumeration. © 2018 The Authors. Cytometry Part A published by Wiley Periodicals, Inc. on behalf of International Society for Advancement of Cytometry.
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Affiliation(s)
- Leonie L Zeune
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands.,Department of Applied Mathematics, University of Twente, Enschede, The Netherlands
| | - Sanne de Wit
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - A M Sofie Berghuis
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Christoph Brune
- Department of Applied Mathematics, University of Twente, Enschede, The Netherlands
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17
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Prognostic significance of CEACAM5mRNA-positive circulating tumor cells in patients with metastatic colorectal cancer. Cancer Chemother Pharmacol 2018; 82:767-775. [DOI: 10.1007/s00280-018-3666-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/04/2018] [Indexed: 01/04/2023]
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18
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Nanou A, Coumans FAW, van Dalum G, Zeune LL, Dolling D, Onstenk W, Crespo M, Fontes MS, Rescigno P, Fowler G, Flohr P, Brune C, Sleijfer S, de Bono JS, Terstappen LWMM. Circulating tumor cells, tumor-derived extracellular vesicles and plasma cytokeratins in castration-resistant prostate cancer patients. Oncotarget 2018; 9:19283-19293. [PMID: 29721202 PMCID: PMC5922396 DOI: 10.18632/oncotarget.25019] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/17/2018] [Indexed: 12/26/2022] Open
Abstract
Purpose The presence of Circulating Tumor Cells (CTCs) in Castration-Resistant Prostate Cancer (CRPC) patients is associated with poor prognosis. In this study, we evaluated the association of clinical outcome in 129 CRPC patients with CTCs, tumor-derived Extracellular Vesicles (tdEVs) and plasma levels of total (CK18) and caspase-cleaved cytokeratin 18 (ccCK18). Experimental Design CTCs and tdEVs were isolated with the CellSearch system and automatically enumerated. Cut-off values dichotomizing patients into favorable and unfavorable groups of overall survival were set on a retrospective data set of 84 patients and validated on a prospective data set of 45 patients. Plasma levels of CK18 and ccCK18 were assessed by ELISAs. Results CTCs, tdEVs and both cytokeratin plasma levels were significantly increased in CRPC patients compared to healthy donors (HDs). All biomarkers except for ccCK18 were prognostic showing a decreased median overall survival for the unfavorable groups of 9.2 vs 21.1, 8.1 vs 23.0 and 10.0 vs 21.5 months respectively. In multivariable Cox regression analysis, tdEVs remained significant. Conclusions Automated CTC and tdEV enumeration allows fast and reliable scoring eliminating inter- and intra- operator variability. tdEVs provide similar prognostic information to CTC counts.
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Affiliation(s)
- Afroditi Nanou
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Frank A W Coumans
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Guus van Dalum
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Leonie L Zeune
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, the Netherlands.,Department of Applied Mathematics, MIRA Institute and Faculty of EEMCS, University of Twente, Enschede, the Netherlands
| | - David Dolling
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Wendy Onstenk
- Department of Medical Oncology, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
| | - Mateus Crespo
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Mariane Sousa Fontes
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom.,Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pasquale Rescigno
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom.,Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gemma Fowler
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Penny Flohr
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Christoph Brune
- Department of Applied Mathematics, MIRA Institute and Faculty of EEMCS, University of Twente, Enschede, the Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
| | - Johann S de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom.,Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, the Netherlands
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19
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Nanou A, Coumans FA, van Dalum G, Zeune LL, Dolling D, Onstenk W, Crespo M, Fontes MS, Rescigno P, Fowler G, Flohr P, Brune C, Sleijfer S, de Bono JS, Terstappen LW. Circulating tumor cells, tumor-derived extracellular vesicles and plasma cytokeratins in castration-resistant prostate cancer patients. Oncotarget 2018. [DOI: 10.18632/oncotarget.25019\] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Afroditi Nanou
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Frank A.W. Coumans
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Guus van Dalum
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Leonie L. Zeune
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, the Netherlands
- Department of Applied Mathematics, MIRA Institute and Faculty of EEMCS, University of Twente, Enschede, the Netherlands
| | - David Dolling
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Wendy Onstenk
- Department of Medical Oncology, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
| | - Mateus Crespo
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Mariane Sousa Fontes
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pasquale Rescigno
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gemma Fowler
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Penny Flohr
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Christoph Brune
- Department of Applied Mathematics, MIRA Institute and Faculty of EEMCS, University of Twente, Enschede, the Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
| | - Johann S. de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Leon W.M.M. Terstappen
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, the Netherlands
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Riethdorf S, O'Flaherty L, Hille C, Pantel K. Clinical applications of the CellSearch platform in cancer patients. Adv Drug Deliv Rev 2018; 125:102-121. [PMID: 29355669 DOI: 10.1016/j.addr.2018.01.011] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 12/29/2022]
Abstract
The CellSearch® system (CS) enables standardized enrichment and enumeration of circulating tumor cells (CTCs) that are repeatedly assessable via non-invasive "liquid biopsy". While the association of CTCs with poor clinical outcome for cancer patients has clearly been demonstrated in numerous clinical studies, utilizing CTCs for the identification of therapeutic targets, stratification of patients for targeted therapies and uncovering mechanisms of resistance is still under investigation. Here, we comprehensively review the current benefits and drawbacks of clinical CTC analyses for patients with metastatic and non-metastatic tumors. Furthermore, the review focuses on approaches beyond CTC enumeration that aim to uncover therapeutically relevant antigens, genomic aberrations, transcriptional profiles and epigenetic alterations of CTCs at a single cell level. This characterization of CTCs may shed light on the heterogeneity and genomic landscapes of malignant tumors, an understanding of which is highly important for the development of new therapeutic strategies.
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21
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EpCAM-based assays for epithelial tumor cell detection in cerebrospinal fluid. J Neurooncol 2017; 137:1-10. [PMID: 29192390 DOI: 10.1007/s11060-017-2691-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/18/2017] [Indexed: 02/07/2023]
Abstract
The diagnosis of leptomeningeal metastases (LM) of solid tumors is complicated due to low sensitivities of both magnetic resonance imaging (MRI) and cytology. MRI has a sensitivity of 76% for the diagnosis of LM and cerebrospinal fluid (CSF) cytology has a sensitivity of 44-67% at first lumbar puncture which increases to 84-91% upon second CSF sampling. Epithelial cell adhesion molecule (EpCAM) is expressed by solid tumors of epithelial origin like non-small-cell lung cancer, breast cancer or ovarium cancer. Recently, a CELLSEARCH® assay and flow cytometry laboratory techniques have been developed to detect circulating tumor cells (CTCs) of epithelial origin in CSF. These laboratory techniques are based on capture antibodies labelled with different fluorescent tags against EpCAM. In this review, we provide an overview of the available laboratory techniques and diagnostic accuracy for tumor cell detection in CSF. The reported sensitivities of the EpCAM-based CTC assays for the diagnosis of LM across the different studies are highly promising and vary between 76 and 100%. An overview of the different EpCAM-based techniques for the enumeration of CTCs in the CSF is given and a comparison is made with CSF cytology for the diagnoses of LM from epithelial tumors.
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Molecular Profiling and Significance of Circulating Tumor Cell Based Genetic Signatures. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 994:143-167. [PMID: 28560673 DOI: 10.1007/978-3-319-55947-6_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cancer kills by metastasizing beyond the primary site. Early detection, surgical intervention and other treatments have improved the survival rates of patients with cancer, however, once metastasis occurs, responses to conventional therapies become significantly less effective, and this remains the leading cause of death. Circulating tumor cells (CTCs) are tumor cells that have preferentially disseminated from the primary tumor mass into the hematological system, and are en route to favorable distant sites where if they survive, can develop into metastases. They may be the earliest detectable cells with metastatic ability, and are gaining increasing attention because of their prognostic value in many types of cancers including breast, prostate, colon and lung. Recent technological advances have removed barriers that previously hindered the detection and isolation of these rare cells from blood, and have exponentially improved the genetic resolution at which we can characterize signatures that define CTCs. Some of the most significant observations from such examinations are described here. Firstly, aberrations that were thought to be unique to CTCs are detected at subclonal frequencies within primary tumors with measurable heterogeneity, indicating pre-existing genetic signatures for metastasis. Secondly, these subclonal events are enriched in CTCs and metastases, pointing towards the selection of a more 'fit' component of tumor cells with survival advantages. Lastly, this component of cancer cells may also be the chemoresistant portion that escapes systemic treatment, or acquires resistance during progression of the disease. The future of cancer management may include a standardized method of measuring intratumor heterogeneity of the primary as well as matched CTCs. This will help identify and target rare aberrations within primary tumors that make them more adept to disseminate, and also to monitor the development of treatment resistant subclones as cancer progresses.
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Xu W, Wu B, Fu L, Chen J, Wang Z, Huang F, Chen J, Zhang M, Zhang Z, Lin J, Lan R, Chen R, Chen W, Chen L, Hong J, Zhang W, Ding Y, Okunieff P, Lin J, Zhang L. Comparison of three different methods for the detection of circulating tumor cells in mice with lung metastasis. Oncol Rep 2017; 37:3219-3226. [PMID: 28498481 PMCID: PMC5442393 DOI: 10.3892/or.2017.5613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/05/2017] [Indexed: 12/12/2022] Open
Abstract
Circulating tumor cells (CTCs) represent the key step of cancer cell dissemination. The alteration of CTCs correlates with the treatment outcome and prognosis. To enrich and identify CTCs from billions of blood cells renders a very challenging task, which triggers development of several methods, including lysis of RBC plus negative or positive enrichment using antibodies, and filter membrane or spiral microfluidics to capture CTCs. To compare the advantages of different enrichment methods for CTCs, we utilized the 4T1 breast cancer cells transfected with both green fluorescent protein (GFP) and luciferase to trace CTCs in the experimental lung metastasis model. Three methods were used to detect CTCs at the same time: bioluminescence assay, smearing method, and membrane filter method. The in vivo alive mouse imaging was used to dynamically monitor the growth of lung metastases. The sensitivity and accuracy of three detection methods were compared side-by-side. Our results showed that 1) the sensitivity of bioluminescence assay was the highest, but there was no information of CTC morphology; 2) the smearing method and membrane filter method could observe the detail of CTC morphology, such as in single or in cluster, while their sensitivity was lower than bioluminescence assay; 3) A dynamic observation at a 7-day intervals, the lung metastatic cancer grew at a log speed, while CTCs were increased at a low speed. This might be due to the activated immune cells eliminating the CTCs at a speed much faster than CTCs were generated. This comparison of three CTC detection methods in mouse model suggests that bioluminescence assay could be used in quantitative study of the effect of certain agent on the suppression of CTCs, while GFP-based morphological assays could be used to study the dissemination mechanism of CTCs. The combination of both bioluminescence assay and GFP-based assay would generate more information for quantity and quality of CTCs.
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Affiliation(s)
- Weifeng Xu
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Bing Wu
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Lengxi Fu
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Junying Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Zeng Wang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Fei Huang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Jinrong Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Mei Zhang
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Zhenhuan Zhang
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Jingan Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Ruilong Lan
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Ruiqing Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Wei Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Long Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Jinsheng Hong
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Weijian Zhang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Yuxiong Ding
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Jianhua Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Lurong Zhang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
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24
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Clinical significance of circulating tumor cells in patients with small-cell lung cancer. TUMORI JOURNAL 2017; 103:242-248. [PMID: 28218384 DOI: 10.5301/tj.5000601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study investigated the correlation of the presence of circulating tumor cells (CTCs) with clinical characteristics, and the predictive value of CTCs for progression-free survival (PFS) in patients with small-cell lung cancer (SCLC). METHODS Samples were obtained from 42 patients with SCLC before and after the first cycle of chemotherapy. CTCs were quantitated by negative immunomagnetic enrichment and immunocytochemistry using anti-CD45 and anti-pancytokeratin antibodies. RESULTS CTCs were positive (≥2) in 76.19% of patients with SCLC and negative in the control group. The presence of CTCs was positively correlated with 6 clinical characteristics. PFS was 6.055 and 10.670 months for patients with ≥2 and <2 CTCs/7.5 mL of blood before chemotherapy; after chemotherapy PFS was 4.862 and 10.535 months, respectively. CONCLUSIONS This study showed that both baseline CTC numbers and the change in CTC numbers after 1 cycle of chemotherapy are significant prognostic factors of PFS for SCLC.
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Swennenhuis JF, van Dalum G, Zeune LL, Terstappen LWMM. Improving the CellSearch® system. Expert Rev Mol Diagn 2016; 16:1291-1305. [PMID: 27797592 DOI: 10.1080/14737159.2016.1255144] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The CellSearch® CTC test enumerates tumor cells present in 7.5 ml blood of cancer patients. improvements, extensions and different utilities of the cellsearch system are discussed in this paper. Areas covered: This paper describes work performed with the CellSearch system, which go beyond the normal scope of the test. All results from searches with the search term 'CellSearch' from Web of Science and PubMed were categorized and discussed. Expert commentary: The CellSearch Circulating Tumor Cell test captures and identifies tumor cells in blood that are associated with poor clinical outcome. How to best use CTC in clinical practice is being explored in many clinical trials. The ability to extract information from the CTC to guide therapy will expand the potential clinical utility of CTC.
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Affiliation(s)
- J F Swennenhuis
- a Medical Cell BioPhysics , University of Twente , Enschede , The Netherlands
| | - G van Dalum
- a Medical Cell BioPhysics , University of Twente , Enschede , The Netherlands
| | - L L Zeune
- a Medical Cell BioPhysics , University of Twente , Enschede , The Netherlands
| | - L W M M Terstappen
- a Medical Cell BioPhysics , University of Twente , Enschede , The Netherlands
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26
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León-Mateos L, Vieito M, Anido U, López López R, Muinelo Romay L. Clinical Application of Circulating Tumour Cells in Prostate Cancer: From Bench to Bedside and Back. Int J Mol Sci 2016; 17:E1580. [PMID: 27657044 PMCID: PMC5037845 DOI: 10.3390/ijms17091580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 01/19/2023] Open
Abstract
Prostate cancer is the most common cancer in men worldwide. To improve future drug development and patient management, surrogate biomarkers associated with relevant outcomes are required. Circulating tumour cells (CTCs) are tumour cells that can enter the circulatory system, and are principally responsible for the development of metastasis at distant sites. In recent years, interest in detecting CTCs as a surrogate biomarker has ghiiukjrown. Clinical studies have revealed that high levels of CTCs in the blood correlate with disease progression in patients with prostate cancer; however, their predictive value for monitoring therapeutic response is less clear. Despite the important progress in CTC clinical development, there are critical requirements for the implementation of their analysis as a routine oncology tool. The goal of the present review is to provide an update on the advances in the clinical validation of CTCs as a surrogate biomarker and to discuss the principal obstacles and main challenges to their inclusion in clinical practice.
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Affiliation(s)
- Luis León-Mateos
- Axencia Galega de Coñecemento en Saúde (ACIS), SERGAS, Avda, Fernando de Casa Novoa, Santiago de Compostela 15707, Spain.
| | - María Vieito
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 4L6, Canada.
| | - Urbano Anido
- Translational Medical Oncology/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Trav. Choupana s/n, Santiago de Compostela 15706, Spain.
| | - Rafael López López
- Translational Medical Oncology/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Trav. Choupana s/n, Santiago de Compostela 15706, Spain.
| | - Laura Muinelo Romay
- Translational Medical Oncology/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Trav. Choupana s/n, Santiago de Compostela 15706, Spain.
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27
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Massard C, Oulhen M, Le Moulec S, Auger N, Foulon S, Abou-Lovergne A, Billiot F, Valent A, Marty V, Loriot Y, Fizazi K, Vielh P, Farace F. Phenotypic and genetic heterogeneity of tumor tissue and circulating tumor cells in patients with metastatic castration-resistant prostate cancer: A report from the PETRUS prospective study. Oncotarget 2016; 7:55069-55082. [PMID: 27391263 PMCID: PMC5342402 DOI: 10.18632/oncotarget.10396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/17/2016] [Indexed: 12/02/2022] Open
Abstract
Molecular characterization of cancer samples is hampered by tumor tissue availability in metastatic castration-resistant prostate cancer (mCRPC) patients. We reported the results of prospective PETRUS study of biomarker assessment in paired primary prostatic tumors, metastatic biopsies and circulating tumor cells (CTCs). Among 54 mCRPC patients enrolled, 38 (70%) had biopsies containing more than 50% tumour cells. 28 (52%) patients were analyzed for both tissue samples and CTCs. FISH for AR-amplification and TMPRSS2-ERG translocation were successful in 54% and 32% in metastatic biopsies and primary tumors, respectively. By comparing CellSearch and filtration (ISET)-enrichment combined to four color immunofluorescent staining, we showed that CellSearch and ISET isolated distinct subpopulations of CTCs: CTCs undergoing epithelial-to-mesenchymal transition, CTC clusters and large CTCs with cytomorphological characteristics but no detectable markers were isolated using ISET. Epithelial CTCs detected by the CellSearch were mostly lost during the ISET-filtration. AR-amplification was detected in CellSearch-captured CTCs, but not in ISET-enriched CTCs which harbor exclusively AR gain of copies. Eighty-eight percent concordance for ERG-rearrangement was observed between metastatic biopsies and CTCs even if additional ERG-alteration patterns were detected in ISET-enriched CTCs indicating a higher heterogeneity in CTCs.Molecular screening of metastatic biopsies is achievable in a multicenter context. Our data indicate that CTCs detected by the CellSearch and the ISET-filtration systems are not only phenotypically but also genetically different. Close attention must be paid to CTC characterization since neither approach tested here fully reflects the tremendous phenotypic and genetic heterogeneity present in CTCs from mCRPC patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Biopsy
- Genetic Heterogeneity
- Humans
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplastic Cells, Circulating/metabolism
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Phenotype
- Prospective Studies
- Prostate/drug effects
- Prostate/metabolism
- Prostate/pathology
- Prostatic Neoplasms, Castration-Resistant/drug therapy
- Prostatic Neoplasms, Castration-Resistant/genetics
- Prostatic Neoplasms, Castration-Resistant/pathology
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Research Report
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Affiliation(s)
- Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Department of Medicine, F-94805, Villejuif, France
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
| | - Marianne Oulhen
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, “Circulating Tumor Cells” Translational Platform, AMMICA CNRS UMS3655 – INSERM US23, F-94805, Villejuif, France
| | - Sylvestre Le Moulec
- Hôpital d'Instruction des Armées du Val de Grâce, Department of Oncology, F-75005, Paris, France
| | - Nathalie Auger
- Gustave Roussy, Université Paris-Saclay, Department of Biopathology, F-94805, Villejuif, France
| | - Stéphanie Foulon
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics and Epidemiology, F-94805, Villejuif, France
| | - Aurélie Abou-Lovergne
- Gustave Roussy, Université Paris-Saclay, Department of Medicine, F-94805, Villejuif, France
| | - Fanny Billiot
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, “Circulating Tumor Cells” Translational Platform, AMMICA CNRS UMS3655 – INSERM US23, F-94805, Villejuif, France
| | - Alexander Valent
- Gustave Roussy, Université Paris-Saclay, Department of Biopathology, F-94805, Villejuif, France
| | - Virginie Marty
- Gustave Roussy, Université Paris-Saclay, “Histo Cytopathology” Translational Platform, AMMICA CNRS UMS3655 – INSERM US23, F-94805, Villejuif, France
| | - Yohann Loriot
- Gustave Roussy, Université Paris-Saclay, Department of Medicine, F-94805, Villejuif, France
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
| | - Karim Fizazi
- Gustave Roussy, Université Paris-Saclay, Department of Medicine, F-94805, Villejuif, France
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
| | - Philippe Vielh
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, “Circulating Tumor Cells” Translational Platform, AMMICA CNRS UMS3655 – INSERM US23, F-94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, Department of Biopathology, F-94805, Villejuif, France
| | - Francoise Farace
- INSERM, U981 “Identification of Molecular Predictors and New Targets for Cancer Treatment”, F-94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, “Circulating Tumor Cells” Translational Platform, AMMICA CNRS UMS3655 – INSERM US23, F-94805, Villejuif, France
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Te Boekhorst V, Friedl P. Plasticity of Cancer Cell Invasion-Mechanisms and Implications for Therapy. Adv Cancer Res 2016; 132:209-64. [PMID: 27613134 DOI: 10.1016/bs.acr.2016.07.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer cell migration is a plastic and adaptive process integrating cytoskeletal dynamics, cell-extracellular matrix and cell-cell adhesion, as well as tissue remodeling. In response to molecular and physical microenvironmental cues during metastatic dissemination, cancer cells exploit a versatile repertoire of invasion and dissemination strategies, including collective and single-cell migration programs. This diversity generates molecular and physical heterogeneity of migration mechanisms and metastatic routes, and provides a basis for adaptation in response to microenvironmental and therapeutic challenge. We here summarize how cytoskeletal dynamics, protease systems, cell-matrix and cell-cell adhesion pathways control cancer cell invasion programs, and how reciprocal interaction of tumor cells with the microenvironment contributes to plasticity of invasion and dissemination strategies. We discuss the potential and future implications of predicted "antimigration" therapies that target cytoskeletal dynamics, adhesion, and protease systems to interfere with metastatic dissemination, and the options for integrating antimigration therapy into the spectrum of targeted molecular therapies.
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Affiliation(s)
- V Te Boekhorst
- David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - P Friedl
- David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Radboud University Medical Centre, Nijmegen, The Netherlands; Cancer Genomics Center (CGC.nl), Utrecht, The Netherlands.
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29
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Circulating Tumour Cells as an Independent Prognostic Factor in Patients with Advanced Oesophageal Squamous Cell Carcinoma Undergoing Chemoradiotherapy. Sci Rep 2016; 6:31423. [PMID: 27530152 PMCID: PMC4987675 DOI: 10.1038/srep31423] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/20/2016] [Indexed: 12/21/2022] Open
Abstract
The role of circulating tumour cells (CTCs) in advanced oesophageal cancer (EC) patients undergoing concurrent chemoradiotherapy (CCRT) remains uncertain. A negative selection protocol plus flow cytometry was validated to efficiently identify CTCs. The CTC number was calculated and analysed for survival impact. The protocol’s efficacy in CTC identification was validated with a recovery rate of 44.6 ± 9.1% and a coefficient of variation of 20.4%. Fifty-seven patients and 20 healthy donors were enrolled. Initial staging, first response to CRT, and surgery after CRT were prognostic for overall survival, with P values of <0.0001, <0.0001, and <0.0001, respectively. The CTC number of EC patients is significantly higher (P = 0.04) than that of healthy donors. Multivariate analysis for disease-specific progression-free survival showed that surgery after response to CCRT, initial stage, and CTC number (≥21.0 cells/mL) played independent prognostic roles. For overall survival, surgery after CCRT, performance status, initial stage, and CTC number were significant independent prognostic factors. In conclusion, a negative selection plus flow cytometry protocol efficiently detected CTCs. The CTC number before CCRT was an independent prognostic factor in patients with unresectable oesophageal squamous cell carcinoma. Further large-scale prospective studies for validation are warranted.
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30
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Perez-Lopez R, Lorente D, Blackledge MD, Collins DJ, Mateo J, Bianchini D, Omlin A, Zivi A, Leach MO, de Bono JS, Koh DM, Tunariu N. Volume of Bone Metastasis Assessed with Whole-Body Diffusion-weighted Imaging Is Associated with Overall Survival in Metastatic Castration-resistant Prostate Cancer. Radiology 2016; 280:151-60. [PMID: 26807894 DOI: 10.1148/radiol.2015150799] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Purpose To determine the correlation between the volume of bone metastasis as assessed with diffusion-weighted (DW) imaging and established prognostic factors in metastatic castration-resistant prostate cancer (mCRPC) and the association with overall survival (OS). Materials and Methods This retrospective study was approved by the institutional review board; informed consent was obtained from all patients. The authors analyzed whole-body DW images obtained between June 2010 and February 2013 in 53 patients with mCRPC at the time of starting a new line of anticancer therapy. Bone metastases were identified and delineated on whole-body DW images in 43 eligible patients. Total tumor diffusion volume (tDV) was correlated with the bone scan index (BSI) and other prognostic factors by using the Pearson correlation coefficient (r). Survival analysis was performed with Kaplan-Meier analysis and Cox regression. Results The median tDV was 503.1 mL (range, 5.6-2242 mL), and the median OS was 12.9 months (95% confidence interval [CI]: 8.7, 16.1 months). There was a significant correlation between tDV and established prognostic factors, including hemoglobin level (r = -0.521, P < .001), prostate-specific antigen level (r = 0.556, P < .001), lactate dehydrogenase level (r = 0.534, P < .001), alkaline phosphatase level (r = 0.572, P < .001), circulating tumor cell count (r = 0.613, P = .004), and BSI (r = 0.565, P = .001). A higher tDV also showed a significant association with poorer OS (hazard ratio, 1.74; 95% CI: 1.02, 2.96; P = .035). Conclusion Metastatic bone disease from mCRPC can be evaluated and quantified with whole-body DW imaging. Whole-body DW imaging-generated tDV showed correlation with established prognostic biomarkers and is associated with OS in mCRPC. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Raquel Perez-Lopez
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - David Lorente
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Matthew D Blackledge
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - David J Collins
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Joaquin Mateo
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Diletta Bianchini
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Aurelius Omlin
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Andrea Zivi
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Martin O Leach
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Johann S de Bono
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Dow-Mu Koh
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Nina Tunariu
- From the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Cancer Therapeutics Division, 15 Cotswold Rd, Sutton SM2 5NG, England
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Tumor-selective replication herpes simplex virus-based technology significantly improves clinical detection and prognostication of viable circulating tumor cells. Oncotarget 2016; 7:39768-39783. [PMID: 27206795 PMCID: PMC5129969 DOI: 10.18632/oncotarget.9465] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/24/2016] [Indexed: 02/05/2023] Open
Abstract
Detection of circulating tumor cells remains a significant challenge due to their vast physical and biological heterogeneity. We developed a cell-surface-marker-independent technology based on telomerase-specific, replication-selective oncolytic herpes-simplex-virus-1 that targets telomerase-reverse-transcriptase-positive cancer cells and expresses green-fluorescent-protein that identifies viable CTCs from a broad spectrum of malignancies. Our method recovered 75.5–87.2% of tumor cells spiked into healthy donor blood, as validated by different methods, including single cell sequencing. CTCs were detected in 59–100% of 326 blood samples from patients with 6 different solid organ carcinomas and lymphomas. Significantly, CTC-positive rates increased remarkably with tumor progression from N0M0, N+M0 to M1 in each of 5 tested cancers (lung, colon, liver, gastric and pancreatic cancer, and glioma). Among 21 non-small cell lung cancer cases in which CTC values were consecutively monitored, 81% showed treatment-related decreases, which was also found after treatments in the other solid tumors. Moreover, monitoring CTC values provided an efficient treatment response indicator in hematological malignancies. Compared to CellSearch, our method detected significantly higher positive rates in 40 NSCLC in all stages, including N0M0, N+M0 and M1, and was less affected by chemotherapy. This simple, robust and clinically-applicable technology detects viable CTCs from solid and hematopoietic malignancies in early to late stages, and significantly improves clinical detection and treatment prognostication.
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Lorente D, Olmos D, Mateo J, Bianchini D, Seed G, Fleisher M, Danila DC, Flohr P, Crespo M, Figueiredo I, Miranda S, Baeten K, Molina A, Kheoh T, McCormack R, Terstappen LWMM, Scher HI, de Bono JS. Decline in Circulating Tumor Cell Count and Treatment Outcome in Advanced Prostate Cancer. Eur Urol 2016; 70:985-992. [PMID: 27289566 PMCID: PMC5568108 DOI: 10.1016/j.eururo.2016.05.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/16/2016] [Indexed: 01/08/2023]
Abstract
Background Treatment response biomarkers are urgently needed for castration-resistant prostate cancer (CRPC). Baseline and post-treatment circulating tumor cell (CTC) counts of ≥5 cells/7.5 ml are associated with poor CRPC outcome. Objective To determine the value of a ≥30% CTC decline as a treatment response indicator. Design, setting, and participants We identified patients with a baseline CTC count ≥5 cells/7.5 ml and evaluable post-treatment CTC counts in two prospective trials. Intervention Patients were treated in the COU-AA-301 (abiraterone after chemotherapy) and IMMC-38 (chemotherapy) trials. Outcome measures and statistical analysis The association between a ≥30% CTC decline after treatment and survival was evaluated using univariable and multivariable Cox regression models at three landmark time points (4, 8, and 12 wk). Model performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and c-indices. Results Overall 486 patients (122 in IMMC-38 and 364 in COU-AA-301) had a CTC count ≥5 cells/7.5 ml at baseline, with 440, 380, and 351 patients evaluable at 4, 8, and 12 wk, respectively. A 30% CTC decline was associated with increased survival at 4 wk (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.36–0.56; p < 0.001), 8 wk (HR 0.41, 95% CI 0.33–0.53; p < 0.001), and 12 wk (HR 0.39, 95% CI 0.3–0.5; p < 0.001) in univariable and multivariable analyses. Stable CTC count (<30% fall or <30% increase) was not associated with a survival benefit when compared with increased CTC count. The association between a 30% CTC decline after treatment and survival was independent of baseline CTC count. CTC declines significantly improved the AUC at all time-points. Finally, in the COU-AA-301 trial, patients with CTC ≥5 cells/7.5 ml and a 30% CTC decline had similar overall survival in both arms. Conclusions A 30% CTC decline after treatment from an initial count ≥5 cells/7.5 ml is independently associated with CRPC overall survival following abiraterone and chemotherapy, improving the performance of a multivariable model as early as 4 wk after treatment. This potential surrogate must now be prospectively evaluated. Patient summary Circulating tumor cells (CTCs) are cancer cells that can be detected in the blood of prostate cancer patients. We analyzed changes in CTCs after treatment with abiraterone and chemotherapy in two large clinical trials, and found that patients who have a decline in CTC count have a better survival outcome.
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Affiliation(s)
- David Lorente
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK; Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; CNIO-IBIMA Genitourinary Cancer Unit, Department of Medical Oncology, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Joaquin Mateo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Diletta Bianchini
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - George Seed
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | | | | | - Penny Flohr
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Mateus Crespo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Ines Figueiredo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Susana Miranda
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Kurt Baeten
- Medical Affairs, Janssen Diagnostics, Beerse, Belgium
| | | | - Thian Kheoh
- Janssen Research & Development, La Jolla, CA, USA
| | | | - Leon W M M Terstappen
- MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Twente, The Netherlands
| | - Howard I Scher
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Johann S de Bono
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK.
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Forte VA, Barrak DK, Elhodaky M, Tung L, Snow A, Lang JE. The potential for liquid biopsies in the precision medical treatment of breast cancer. Cancer Biol Med 2016; 13:19-40. [PMID: 27144060 PMCID: PMC4850125 DOI: 10.28092/j.issn.2095-3941.2016.0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Currently the clinical management of breast cancer relies on relatively few prognostic/predictive clinical markers (estrogen receptor, progesterone receptor, HER2), based on primary tumor biology. Circulating biomarkers, such as circulating tumor DNA (ctDNA) or circulating tumor cells (CTCs) may enhance our treatment options by focusing on the very cells that are the direct precursors of distant metastatic disease, and probably inherently different than the primary tumor's biology. To shift the current clinical paradigm, assessing tumor biology in real time by molecularly profiling CTCs or ctDNA may serve to discover therapeutic targets, detect minimal residual disease and predict response to treatment. This review serves to elucidate the detection, characterization, and clinical application of CTCs and ctDNA with the goal of precision treatment of breast cancer.
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Affiliation(s)
- Victoria A Forte
- Department of Medicine, Division of Medical Oncology, University of Southern California (USC), Los Angeles, CA 90033, USA; USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Dany K Barrak
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, USC, Los Angeles, CA 90033, USA
| | - Mostafa Elhodaky
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Stem Cell and Regenerative Medicine, USC, Los Angeles, CA 90033, USA
| | - Lily Tung
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, USC, Los Angeles, CA 90033, USA
| | - Anson Snow
- Department of Medicine, Division of Medical Oncology, University of Southern California (USC), Los Angeles, CA 90033, USA; USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Julie E Lang
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, USC, Los Angeles, CA 90033, USA
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Park ES, Jin C, Guo Q, Ang RR, Duffy SP, Matthews K, Azad A, Abdi H, Todenhöfer T, Bazov J, Chi KN, Black PC, Ma H. Continuous Flow Deformability-Based Separation of Circulating Tumor Cells Using Microfluidic Ratchets. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2016; 12:1909-19. [PMID: 26917414 DOI: 10.1002/smll.201503639] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/06/2016] [Indexed: 05/03/2023]
Abstract
Circulating tumor cells (CTCs) offer tremendous potential for the detection and characterization of cancer. A key challenge for their isolation and subsequent analysis is the extreme rarity of these cells in circulation. Here, a novel label-free method is described to enrich viable CTCs directly from whole blood based on their distinct deformability relative to hematological cells. This mechanism leverages the deformation of single cells through tapered micrometer scale constrictions using oscillatory flow in order to generate a ratcheting effect that produces distinct flow paths for CTCs, leukocytes, and erythrocytes. A label-free separation of circulating tumor cells from whole blood is demonstrated, where target cells can be separated from background cells based on deformability despite their nearly identical size. In doping experiments, this microfluidic device is able to capture >90% of cancer cells from unprocessed whole blood to achieve 10(4) -fold enrichment of target cells relative to leukocytes. In patients with metastatic castration-resistant prostate cancer, where CTCs are not significantly larger than leukocytes, CTCs can be captured based on deformability at 25× greater yield than with the conventional CellSearch system. Finally, the CTCs separated using this approach are collected in suspension and are available for downstream molecular characterization.
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Affiliation(s)
- Emily S Park
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Chao Jin
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Quan Guo
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Richard R Ang
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Simon P Duffy
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Kerryn Matthews
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Arun Azad
- BC Cancer Agency-Vancouver Cancer Centre, 600 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Hamidreza Abdi
- Vancouver Prostate Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Tilman Todenhöfer
- Vancouver Prostate Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Jenny Bazov
- Vancouver Prostate Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Kim N Chi
- BC Cancer Agency-Vancouver Cancer Centre, 600 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
- Vancouver Prostate Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Peter C Black
- Vancouver Prostate Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Hongshen Ma
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
- Vancouver Prostate Centre, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
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Lianidou ES, Markou A, Strati A. The Role of CTCs as Tumor Biomarkers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 867:341-67. [PMID: 26530376 DOI: 10.1007/978-94-017-7215-0_21] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Detection of Circulating Tumor Cells (CTCs) in peripheral blood can serve as a "liquid biopsy" approach and as a source of valuable tumor markers. CTCs are rare, and thus their detection, enumeration and molecular characterization are very challenging. CTCs have the unique characteristic to be non-invasively isolated from blood and used to follow patients over time, since these cells can provide significant information for better understanding tumour biology and tumour cell dissemination. CTCs molecular characterization offers the unique potential to understand better the biology of metastasis and resistance to established therapies and their analysis presents nowadays a promising field for both advanced and early stage patients. In this chapter we focus on the latest findings concerning the clinical relevance of CTC detection and enumeration, and discuss their potential as tumor biomarkers in various types of solid cancers. We also highlight the importance of performing comparison studies between these different methodologies and external quality control systems for establishing CTCs as tumor biomarkers in the routine clinical setting.
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Affiliation(s)
- Evi S Lianidou
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, University of Athens, 15771, Athens, Greece.
| | - Athina Markou
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, University of Athens, 15771, Athens, Greece
| | - Areti Strati
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, University of Athens, 15771, Athens, Greece
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Reijm EA, Sieuwerts AM, Smid M, Vries JBD, Mostert B, Onstenk W, Peeters D, Dirix LY, Seynaeve CM, Jager A, de Jongh FE, Hamberg P, van Galen A, Kraan J, Jansen MPHM, Gratama JW, Foekens JA, Martens JWM, Berns EMJJ, Sleijfer S. An 8-gene mRNA expression profile in circulating tumor cells predicts response to aromatase inhibitors in metastatic breast cancer patients. BMC Cancer 2016; 16:123. [PMID: 26892682 PMCID: PMC4759736 DOI: 10.1186/s12885-016-2155-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/10/2016] [Indexed: 12/29/2022] Open
Abstract
Background Molecular characterization of circulating tumor cells (CTC) is promising for personalized medicine. We aimed to identify a CTC gene expression profile predicting outcome to first-line aromatase inhibitors in metastatic breast cancer (MBC) patients. Methods: CTCs were isolated from 78 MBC patients before treatment start. mRNA expression levels of 96 genes were measured by quantitative reverse transcriptase polymerase chain reaction. After applying predefined exclusion criteria based on lack of sufficient RNA quality and/or quantity, the data from 45 patients were used to construct a gene expression profile to predict poor responding patients, defined as disease progression or death <9 months, by a leave-one-out cross validation. Results Of the 45 patients, 19 were clinically classified as poor responders. To identify them, the 75 % most variable genes were used to select genes differentially expressed between good and poor responders. An 8-gene CTC predictor was significantly associated with outcome (Hazard Ratio [HR] 4.40, 95 % Confidence Interval [CI]: 2.17–8.92, P < 0.001). This predictor identified poor responding patients with a sensitivity of 63 % and a positive predictive value of 75 %, while good responding patients were correctly predicted in 85 % of the cases. In multivariate Cox regression analysis, including CTC count at baseline, the 8-gene CTC predictor was the only factor independently associated with outcome (HR 4.59 [95 % CI: 2.11–9.56], P < 0.001). This 8-gene signature was not associated with outcome in a group of 71 MBC patients treated with systemic treatments other than AI. Conclusions An 8-gene CTC predictor was identified which discriminates good and poor outcome to first-line aromatase inhibitors in MBC patients. Although results need to be validated, this study underscores the potential of molecular characterization of CTCs. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2155-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther A Reijm
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Anieta M Sieuwerts
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Marcel Smid
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Joan Bolt-de Vries
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Bianca Mostert
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Wendy Onstenk
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Dieter Peeters
- Translational Cancer Research Unit, Oncology Center GZA Hospitals Sint-Augustinus and Department of Oncology, University of Antwerp, Antwerp, Belgium
| | - Luc Y Dirix
- Translational Cancer Research Unit, Oncology Center GZA Hospitals Sint-Augustinus and Department of Oncology, University of Antwerp, Antwerp, Belgium
| | - Caroline M Seynaeve
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Felix E de Jongh
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Paul Hamberg
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Anne van Galen
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Jaco Kraan
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Maurice P H M Jansen
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Jan W Gratama
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - John A Foekens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - John W M Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Els M J J Berns
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC - Cancer Institute, Erasmus University Medical Center, Room He 116, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands.
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Chudziak J, Burt DJ, Mohan S, Rothwell DG, Mesquita B, Antonello J, Dalby S, Ayub M, Priest L, Carter L, Krebs MG, Blackhall F, Dive C, Brady G. Clinical evaluation of a novel microfluidic device for epitope-independent enrichment of circulating tumour cells in patients with small cell lung cancer. Analyst 2016; 141:669-78. [PMID: 26605519 DOI: 10.1039/c5an02156a] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Circulating tumour cells (CTCs) have potential utility as minimally-invasive biomarkers to aid cancer treatment decision making. However, many current CTC technologies enrich CTCs using specific surface epitopes that do not necessarily reflect CTC heterogeneity. Here we evaluated the epitope-independent Parsortix system which enriches CTCs based on size and rigidity using both healthy normal volunteer blood samples spiked with tumour cells and blood samples from patients with small cell lung cancer (SCLC). Blood samples were maintained unfractionated at room temperature for up to 4 days followed by plasma removal for circulating free DNA (cfDNA) isolation and direct application of the remaining cell component to the Parsortix system. For tumour cells expressing the EpCAM cell surface marker the numbers of spiked cells retained using the Parsortix system and by EpCAM-positive selection using CellSearch® were not significantly different, whereas only the Parsortix system showed strong enrichment of cells with undetectable EpCAM expression. In a pilot clinical study we banked both enriched CTCs as well as plasma from SCLC patient blood samples. Upon retrieval of the banked Parsortix cellular samples we could detect cytokeratin positive CTCs in all 12 SCLC patients tested. Interestingly, processing parallel samples from the same patients by EpCAM enrichment using CellSearch® revealed only 83% (10/12) with cytokeratin positive CTCs indicating the Parsortix system is enriching for EpCAM negative SCLC CTCs. Our combined results indicate the Parsortix system is a valuable tool for combined cfDNA isolation and CTC enrichment that enables CTC analysis to be extended beyond dependence on surface epitopes.
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Affiliation(s)
- Jakub Chudziak
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Deborah J Burt
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Sumitra Mohan
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Dominic G Rothwell
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Bárbara Mesquita
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Jenny Antonello
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Suzanne Dalby
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Mahmood Ayub
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Lynsey Priest
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Louise Carter
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Matthew G Krebs
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Fiona Blackhall
- Christie NHS Foundation Trust, Manchester, UK and Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
| | - Ged Brady
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK.
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38
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Bidard FC, Proudhon C, Pierga JY. Circulating tumor cells in breast cancer. Mol Oncol 2016; 10:418-30. [PMID: 26809472 PMCID: PMC5528978 DOI: 10.1016/j.molonc.2016.01.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/12/2015] [Accepted: 01/04/2016] [Indexed: 01/06/2023] Open
Abstract
Over the past decade, technically reliable circulating tumor cell (CTC) detection methods allowed the collection of large datasets of CTC counts in cancer patients. These data can be used either as a dynamic prognostic biomarker or as tumor material for “liquid biopsy”. Breast cancer appears to be the cancer type in which CTC have been the most extensively studied so far, with level‐of‐evidence‐1 studies supporting the clinical validity of CTC count in both early and metastatic stage. This review summarizes and discusses the clinical results obtained in breast cancer patients, the issues faced by the molecular characterization of CTC and the biological findings about cancer biology and metastasis that were obtained from CTC. In metastatic breast cancer, CTC count is a level‐of‐evidence 1 prognostic dynamic biomarker. Several interventional trials are ongoing to demonstrate the clinical utility of CTC detection in metastatic breast cancer. In early breast cancer, CTC count is also a prognostic biomarker, not correlated with the other usual prognostic factors. Molecular characterization of CTC is promising, trials with anti‐HER2 therapy are ongoing.
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Affiliation(s)
- Francois-Clement Bidard
- Institut Curie, PSL Research University, SiRIC, Laboratory of Circulating Tumor Biomarkers, Paris, France; Institut Curie, PSL Research University, Department of Medical Oncology, Paris, France
| | - Charlotte Proudhon
- Institut Curie, PSL Research University, SiRIC, Laboratory of Circulating Tumor Biomarkers, Paris, France
| | - Jean-Yves Pierga
- Institut Curie, PSL Research University, SiRIC, Laboratory of Circulating Tumor Biomarkers, Paris, France; Institut Curie, PSL Research University, Department of Medical Oncology, Paris, France; Université Paris Descartes, Paris, France.
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Andree KC, van Dalum G, Terstappen LWMM. Challenges in circulating tumor cell detection by the CellSearch system. Mol Oncol 2015; 10:395-407. [PMID: 26795350 DOI: 10.1016/j.molonc.2015.12.002] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/19/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022] Open
Abstract
Enumeration and characterization of circulating tumor cells (CTC) hold the promise of a real time liquid biopsy. They are however present in a large background of hematopoietic cells making their isolation technically challenging. In 2004, the CellSearch system was introduced as the first and only FDA cleared method designed for the enumeration of circulating tumor cells in 7.5 mL of blood. Presence of CTC detected by CellSearch is associated with poor prognosis in metastatic carcinomas. CTC remaining in patients after the first cycles of therapy indicates a futile therapy. Here we review challenges faced during the development of the CellSearch system and the difficulties in assigning objects as CTC. The large heterogeneity of CTC and the different approaches introduced in recent years to isolate, enumerate and characterize CTC results in a large variation of the number of CTC reported urging the need for uniform definitions and at least a clear definition of what the criteria are for assigning an object as a CTC.
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Affiliation(s)
- Kiki C Andree
- Department of Medical Cell BioPhysics, University of Twente, Hallenweg 23, 7522 NH Enschede, The Netherlands
| | - Guus van Dalum
- Department of Medical Cell BioPhysics, University of Twente, Hallenweg 23, 7522 NH Enschede, The Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Hallenweg 23, 7522 NH Enschede, The Netherlands.
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40
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Lorente D, Mateo J, de Bono JS. Molecular characterization and clinical utility of circulating tumor cells in the treatment of prostate cancer. Am Soc Clin Oncol Educ Book 2015:e197-203. [PMID: 24857103 DOI: 10.14694/edbook_am.2014.34.e197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Circulating tumor cells (CTCs) are rare cancer cells that can be detected in the blood of patients with solid malignancies. The Veridex CellSearch Assay was analytically and clinically validated, and has received U.S. Food and Drug Administration (FDA) clearance for the enumeration of CTCs in breast, colorectal, and prostate cancer. A number of alternative assays, with potential advantages, are currently undergoing clinical and/or analytic validation before their routine use can be established. In prostate cancer, high pretreatment CTC counts have been associated with worse survival, and changes in CTC counts in response to treatment have been established as indicators of response to treatment. Additional analyses are ongoing to establish the value of CTC counts as a surrogate of survival in prospective, phase III trials, which could influence the process of drug development and regulatory approval. Additionally, CTCs have a potential role in the molecular characterization of prostate cancer, serving as "liquid biopsies" to determine the molecular characteristics of the disease. The study of androgen receptor (AR) mutations or amplification, chromosomal rearrangements, or the determination of DNA repair biomarkers has been evaluated in clinical trials. CTCs have a wide range of potential applications, from their prognostic use in stratification of patients in clinical trials or the assessment of response to treatment, to the pharmacodynamic evaluation of novel agents, or the discovery and use of predictive biomarkers that can aid in the development of personalized medicine.
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Affiliation(s)
- David Lorente
- From the Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey, UK; Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Joaquin Mateo
- From the Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey, UK; Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Johann S de Bono
- From the Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey, UK; Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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41
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He Q, Guo S, Qian Z, Chen X. Development of individualized anti-metastasis strategies by engineering nanomedicines. Chem Soc Rev 2015; 44:6258-86. [PMID: 26056688 PMCID: PMC4540626 DOI: 10.1039/c4cs00511b] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Metastasis is deadly and also tough to treat as it is much more complicated than the primary tumour. Anti-metastasis approaches available so far are far from being optimal. A variety of nanomedicine formulae provide a plethora of opportunities for developing new strategies and means for tackling metastasis. It should be noted that individualized anti-metastatic nanomedicines are different from common anti-cancer nanomedicines as they specifically target different populations of malignant cells. This review briefly introduces the features of the metastatic cascade, and proposes a series of nanomedicine-based anti-metastasis strategies aiming to block each metastatic step. Moreover, we also concisely introduce the advantages of several promising nanoparticle platforms and their potential for constructing state-of-the-art individualized anti-metastatic nanomedicines.
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Affiliation(s)
- Qianjun He
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Shengrong Guo
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, P.R. China
| | - Zhiyong Qian
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda, MD 20892, USA
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Qian W, Zhang Y, Chen W. Capturing Cancer: Emerging Microfluidic Technologies for the Capture and Characterization of Circulating Tumor Cells. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2015; 11:3850-72. [PMID: 25993898 DOI: 10.1002/smll.201403658] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/13/2015] [Indexed: 05/04/2023]
Abstract
Circulating tumor cells (CTCs) escape from primary or metastatic lesions and enter into circulation, carrying significant information of cancer progression and metastasis. Capture of CTCs from the bloodstream and the characterization of these cells hold great significance for the detection, characterization, and monitoring of cancer. Despite the urgent need from clinics, it remains a major challenge to capture and retain these rare cells from human blood with high specificity and yield. Recent exciting advances in micro/nanotechnology, microfluidics, and materials science have enable versatile, robust, and efficient cell isolation and processing through the development of new micro/nanoengineered devices and biomaterials. This review provides a summary of recent progress along this direction, with a focus on emerging methods for CTC capture and processing, and their application in cancer research. Furthermore, classical as well as emerging cellular characterization methods are reviewed to reveal the role of CTCs in cancer progression and metastasis, and hypotheses are proposed in regard to the potential emerging research directions most desired in CTC-related cancer research.
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Affiliation(s)
- Weiyi Qian
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, NY, 11201, USA
| | - Yan Zhang
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, NY, 11201, USA
| | - Weiqiang Chen
- Department of Mechanical and Aerospace Engineering, New York University, Brooklyn, NY, 11201, USA
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Polzer B, Medoro G, Pasch S, Fontana F, Zorzino L, Pestka A, Andergassen U, Meier-Stiegen F, Czyz ZT, Alberter B, Treitschke S, Schamberger T, Sergio M, Bregola G, Doffini A, Gianni S, Calanca A, Signorini G, Bolognesi C, Hartmann A, Fasching PA, Sandri MT, Rack B, Fehm T, Giorgini G, Manaresi N, Klein CA. Molecular profiling of single circulating tumor cells with diagnostic intention. EMBO Mol Med 2015; 6:1371-86. [PMID: 25358515 PMCID: PMC4237466 DOI: 10.15252/emmm.201404033] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Several hundred clinical trials currently explore the role of circulating tumor cell (CTC) analysis for therapy decisions, but assays are lacking for comprehensive molecular characterization of CTCs with diagnostic precision. We therefore combined a workflow for enrichment and isolation of pure CTCs with a non-random whole genome amplification method for single cells and applied it to 510 single CTCs and 189 leukocytes of 66 CTC-positive breast cancer patients. We defined a genome integrity index (GII) to identify single cells suited for molecular characterization by different molecular assays, such as diagnostic profiling of point mutations, gene amplifications and whole genomes of single cells. The reliability of > 90% for successful molecular analysis of high-quality clinical samples selected by the GII enabled assessing the molecular heterogeneity of single CTCs of metastatic breast cancer patients. We readily identified genomic disparity of potentially high relevance between primary tumors and CTCs. Microheterogeneity analysis among individual CTCs uncovered pre-existing cells resistant to ERBB2-targeted therapies suggesting ongoing microevolution at late-stage disease whose exploration may provide essential information for personalized treatment decisions and shed light into mechanisms of acquired drug resistance.
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Affiliation(s)
- Bernhard Polzer
- Project Group "Personalized Tumor Therapy", Fraunhofer Institute for Toxicology und Experimental Medicine, Regensburg, Germany
| | | | - Sophie Pasch
- Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | | | - Laura Zorzino
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Aurelia Pestka
- Department of Gynecology and Obstetrics, University Munich, Munich, Germany
| | - Ulrich Andergassen
- Department of Gynecology and Obstetrics, University Munich, Munich, Germany
| | | | - Zbigniew T Czyz
- Project Group "Personalized Tumor Therapy", Fraunhofer Institute for Toxicology und Experimental Medicine, Regensburg, Germany Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | - Barbara Alberter
- Project Group "Personalized Tumor Therapy", Fraunhofer Institute for Toxicology und Experimental Medicine, Regensburg, Germany
| | - Steffi Treitschke
- Project Group "Personalized Tumor Therapy", Fraunhofer Institute for Toxicology und Experimental Medicine, Regensburg, Germany
| | - Thomas Schamberger
- Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | | | - Arndt Hartmann
- Department of Pathology, University Erlangen, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Erlangen, Erlangen, Germany
| | - Maria T Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Munich, Munich, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University of Düsseldorf, Düsseldorf, Germany
| | | | | | - Christoph A Klein
- Project Group "Personalized Tumor Therapy", Fraunhofer Institute for Toxicology und Experimental Medicine, Regensburg, Germany Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
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Qin X, Park S, Duffy SP, Matthews K, Ang RR, Todenhöfer T, Abdi H, Azad A, Bazov J, Chi KN, Black PC, Ma H. Size and deformability based separation of circulating tumor cells from castrate resistant prostate cancer patients using resettable cell traps. LAB ON A CHIP 2015; 15:2278-86. [PMID: 25876237 DOI: 10.1039/c5lc00226e] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The enumeration and capture of circulating tumor cells (CTCs) are potentially of great clinical value as they offer a non-invasive means to access tumor materials to diagnose disease and monitor treatment efficacy. Conventional immunoenrichment of CTCs may fail to capture cells with low surface antigen expression. Micropore filtration presents a compelling label-free alternative that enriches CTCs using their biophysical rather than biochemical characteristics. However, this strategy is prone to clogging of the filter microstructure, which dramatically reduces the selectivity after processing large numbers of cells. Here, we use the resettable cell trap (RCT) mechanism to separate cells based on their size and deformability using an adjustable aperture that can be periodically cleared to prevent clogging. After separation, the output sample is stained and analyzed using multi-spectral analysis, which provides a more sensitive and unambiguous method to identify CTC biomarkers than traditional immunofluorescence. We tested the RCT device using blood samples obtained from 22 patients with metastatic castrate-resistant prostate cancer while comparing the results with the established CellSearch® system. The RCT mechanism was able to capture ≥5 CTCs in 18/22 (82%) patients with a mean count of 257 in 7.5 ml of whole blood, while the CellSearch system found ≥5 CTCs in 9/22 (41%) patients with a mean count of 25. The ~10× improvement in the CTC capture rate provides significantly more materials for subsequent analysis of these cells such as immunofluorescence, propagation by tissue culture, and genetic profiling.
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Affiliation(s)
- Xi Qin
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada.
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45
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Autebert J, Coudert B, Champ J, Saias L, Guneri ET, Lebofsky R, Bidard FC, Pierga JY, Farace F, Descroix S, Malaquin L, Viovy JL. High purity microfluidic sorting and analysis of circulating tumor cells: towards routine mutation detection. LAB ON A CHIP 2015; 15:2090-101. [PMID: 25815443 DOI: 10.1039/c5lc00104h] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A new generation of the Ephesia cell capture technology optimized for CTC capture and genetic analysis is presented, characterized in depth and compared with the CellSearch system as a reference. This technology uses magnetic particles bearing tumour-cell specific EpCAM antibodies, self-assembled in a regular array in a microfluidic flow cell. 48,000 high aspect-ratio columns are generated using a magnetic field in a high throughput (>3 ml h(-1)) device and act as sieves to specifically capture the cells of interest through antibody-antigen interactions. Using this device optimized for CTC capture and analysis, we demonstrated the capture of epithelial cells with capture efficiency above 90% for concentrations as low as a few cells per ml. We showed the high specificity of capture with only 0.26% of non-epithelial cells captured for concentrations above 10 million cells per ml. We investigated the capture behavior of cells in the device, and correlated the cell attachment rate with the EpCAM expression on the cell membranes for six different cell lines. We developed and characterized a two-step blood processing method to allow for rapid processing of 10 ml blood tubes in less than 4 hours, and showed a capture rate of 70% for as low as 25 cells spiked in 10 ml blood tubes, with less than 100 contaminating hematopoietic cells. Using this device and procedure, we validated our system on patient samples using an automated cell immunostaining procedure and a semi-automated cell counting method. Our device captured CTCs in 75% of metastatic prostate cancer patients and 80% of metastatic breast cancer patients, and showed similar or better results than the CellSearch device in 10 out of 13 samples. Finally, we demonstrated the possibility of detecting cancer-related PIK3CA gene mutation in 20 cells captured in the chip with a good correlation between the cell count and the quantitation value Cq of the post-capture qPCR.
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Affiliation(s)
- Julien Autebert
- Institut Curie, Centre National de la Recherche Scientifique, Université Pierre et Marie Curie, PSL Research University, Unité Mixte de Recherche 168, 75005 Paris, France.
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46
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Yap TA, Lorente D, Omlin A, Olmos D, de Bono JS. Circulating tumor cells: a multifunctional biomarker. Clin Cancer Res 2015; 20:2553-68. [PMID: 24831278 DOI: 10.1158/1078-0432.ccr-13-2664] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One of the most promising developments in translational cancer medicine has been the emergence of circulating tumor cells (CTC) as a minimally invasive multifunctional biomarker. CTCs in peripheral blood originate from solid tumors and are involved in the process of hematogenous metastatic spread to distant sites for the establishment of secondary foci of disease. The emergence of modern CTC technologies has enabled serial assessments to be undertaken at multiple time points along a patient's cancer journey for pharmacodynamic (PD), prognostic, predictive, and intermediate endpoint biomarker studies. Despite the promise of CTCs as multifunctional biomarkers, there are still numerous challenges that hinder their incorporation into standard clinical practice. This review discusses the key technical aspects of CTC technologies, including the importance of assay validation and clinical qualification, and compares existing and novel CTC enrichment platforms. This article discusses the utility of CTCs as a multifunctional biomarker and focuses on the potential of CTCs as PD endpoints either directly via the molecular characterization of specific markers or indirectly through CTC enumeration. We propose strategies for incorporating CTCs as PD biomarkers in translational clinical trials, such as the Pharmacological Audit Trail. We also discuss issues relating to intrapatient heterogeneity and the challenges associated with isolating CTCs undergoing epithelial-mesenchymal transition, as well as apoptotic and small CTCs. Finally, we envision the future promise of CTCs for the selection and monitoring of antitumor precision therapies, including applications in single CTC phenotypic and genomic profiling and CTC-derived xenografts, and discuss the promises and limitations of such approaches. See ALL articles in this CCR focus section, "Progress in pharmacodynamic endpoints."
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Affiliation(s)
- Timothy A Yap
- Authors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, SpainAuthors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, Spain
| | - David Lorente
- Authors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, SpainAuthors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, Spain
| | - Aurelius Omlin
- Authors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, Spain
| | - David Olmos
- Authors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, Spain
| | - Johann S de Bono
- Authors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, SpainAuthors' Affiliations: Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Kantonsspital St. Gallen, Department of Medical Oncology, Gallen, Switzerland; and Spanish National Cancer Research Centre, Madrid, Spain
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47
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Beije N, Jager A, Sleijfer S. Circulating tumor cell enumeration by the CellSearch system: The clinician’s guide to breast cancer treatment? Cancer Treat Rev 2015; 41:144-50. [DOI: 10.1016/j.ctrv.2014.12.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 02/02/2023]
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48
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Rink M, Soave A, Engel O, Fisch M, Riethdorf S, Pantel K. [Tumor cells in the peripheral blood of patients with urothelial carcinoma of the bladder: detection and impact of circulating]. Urologe A 2014; 53:501-8. [PMID: 24671248 DOI: 10.1007/s00120-014-3443-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Circulating tumor cells (CTC) play a crucial role in the natural history of several malignancies and, thus, are the subject of intense research efforts. This review summarizes the most contemporary literature data regarding detection of CTC and their impact on the oncological prognosis of patients with urothelial carcinoma of the bladder (UCB). Despite the availability of different methods for CTC detection and isolation in the peripheral blood, the standardized and Food and Drug Administration-approved CellSearch® assay is currently the most commonly used system for CTC detection. The majority of studies did not find any association between presence of CTC and clinicopathologic features. However, CTC have been demonstrated to represent a strong, independent predictor for unfavorable oncological outcomes in UCB. Since the peripheral blood is an easily accessible source, CTC represent a promising biomarker to effectively monitor early disease progression and therapy response in the near future. CTC hold the potential to individualize patient counseling regarding the optimal timing of radical surgery or bladder-sparing treatment as well as multimodal therapies.
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Affiliation(s)
- M Rink
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
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49
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Mateo J, Gerlinger M, Rodrigues DN, de Bono JS. The promise of circulating tumor cell analysis in cancer management. Genome Biol 2014. [PMID: 25222379 DOI: 10.1186/s13059‐014‐0448‐5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Enumeration and molecular characterization of circulating tumor cells isolated from peripheral blood of patients with cancer can aid selection of targeted therapy for patients, monitoring of response to therapies and optimization of drug development, while also providing valuable information about intratumoral heterogeneity.
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50
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Mateo J, Gerlinger M, Rodrigues DN, de Bono JS. The promise of circulating tumor cell analysis in cancer management. Genome Biol 2014; 15:448. [PMID: 25222379 PMCID: PMC4281949 DOI: 10.1186/s13059-014-0448-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Enumeration and molecular characterization of circulating tumor cells isolated from peripheral blood of patients with cancer can aid selection of targeted therapy for patients, monitoring of response to therapies and optimization of drug development, while also providing valuable information about intratumoral heterogeneity.
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Affiliation(s)
- Joaquin Mateo
- />Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG UK
- />Drug Development Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK
| | - Marco Gerlinger
- />Centre for Evolution and Cancer, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
- />Gastrointestinal Cancer Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Daniel Nava Rodrigues
- />Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG UK
- />Drug Development Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK
| | - Johann S de Bono
- />Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG UK
- />Drug Development Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK
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