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Clinical Relevance and Therapeutic Application of CTCs in Advanced Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32304085 DOI: 10.1007/978-3-030-35805-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Precision medicine through liquid biopsy represents an emerging approach in the management of cancer. The CTC count in blood samples from patients with advanced breast cancer is a powerful prognostic factor for both progression free and overall survival. Moreover, high levels of CTCs at any time during the treatment can reliably predict progression before imaging studies and/or tumor markers. Furthermore, there are works on the molecular characterization of the CTCs and their potential ability to guide the treatment in a dynamic way. However, their role remains controversial. Detection and enumeration of CTCs is variable among different tumors and is subjected to biases related mainly to their methodology, which is not completely standardized. In addition, they must demonstrate their clinical value to guide the treatment and a translation on patient's survival.
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2
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Hemodynamic shear stress stimulates migration and extravasation of tumor cells by elevating cellular oxidative level. Cancer Lett 2017; 388:239-248. [DOI: 10.1016/j.canlet.2016.12.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022]
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3
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Ge F, Zhang H, Wang DD, Li L, Lin PP. Enhanced detection and comprehensive in situ phenotypic characterization of circulating and disseminated heteroploid epithelial and glioma tumor cells. Oncotarget 2016; 6:27049-64. [PMID: 26267323 PMCID: PMC4694973 DOI: 10.18632/oncotarget.4819] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/17/2015] [Indexed: 12/27/2022] Open
Abstract
Conventional strategy of anti-EpCAM capture and immunostaining of cytokeratins (CKs) to detect circulating tumor cells (CTCs) is limited by highly heterogeneous and dynamic expression or absence of EpCAM and/or CKs in CTCs. In this study, a novel integrated cellular and molecular approach of subtraction enrichment (SE) and immunostaining-FISH (iFISH) was successfully developed. Both large or small size CTCs and circulating tumor microemboli (CTM) in various biofluid samples including cerebrospinal fluid (CSF) of cancer patients and patient-derived-xenograft (PDX) mouse models were efficiently enriched and comprehensively identified and characterized by SE-iFISH. Non-hematopoietic CTCs with heteroploid chromosome 8 were detected in 87–92% of lung, esophageal and gastric cancer patients. Characterization of CTCs performed by CK18-iFISH showed that CK18, the dual epithelial marker and tumor biomarker, was strong positive in only 14% of lung and 24% of esophageal CTCs, respectively. Unlike conventional methodologies restricted only to the large and/or both EpCAM and CK positive CTCs, SE-iFISH enables efficient enrichment and performing in situ phenotypic and karyotypic identification and characterization of the highly heterogeneous CTC subtypes classified by both chromosome ploidy and the expression of various tumor biomarkers. Each CTC subtype may possess distinct clinical significance relative to tumor metastasis, relapse, therapeutic drug sensitivity or resistance, etc.
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Affiliation(s)
- Feng Ge
- Department of Thoracic Surgery, Capital Medical University School of Oncology and Chaoyang Hospital, Beijing, China
| | - Haishi Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Linda Li
- Cytelligen, San Diego, California, USA
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4
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Das A, Kunkel M, Joudeh J, Dicker DT, Scicchitano A, Allen JE, Sarwani N, Yang Z, Kaifi J, Zhu J, Liao J, El-Deiry WS. Clinico-pathological correlation of serial measurement of circulating tumor cells in 24 metastatic colorectal cancer patients receiving chemotherapy reveals interpatient heterogeneity correlated with CEA levels but independent of KRAS and BRAF mutation. Cancer Biol Ther 2016; 16:709-13. [PMID: 25806877 DOI: 10.1080/15384047.2015.1030555] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The Veridex CellSearch is an FDA-approved technology for enumerating circulating tumor cells in blood samples of metastatic colorectal cancer mCRC) patients and has prognostic value. It is important to understand how counts of circulating tumor cells (CTCs), which are advocated to be tools for "liquid biopsy" of tumors, correlate with clinical and pathologic variables of significance in these patients. In this study, we have attempted to make such correlations along with evaluating how CTC counts change during the course of chemotherapy. PATIENTS AND METHODS Following an IRB-approved protocol, blood samples were collected from 24 patients with mCRC along with relevant clinico-pathological data. Blood was collected at defined time-points both prior to as well as during the course of treatment with combination chemotherapy, and CTC counts were enumerated from 7.5 ml of blood. RESULTS Seventeen out of 24 patients with mCRC showed a CTC count of 2 or less cells in 7.5 ml of blood at base-line assessment before chemotherapy while 7 patients showed 3 or more cells in 7.5 ml of blood at that point. A correlation was found between high carcino-embryonic antigen (CEA) levels and high CTC counts (P = 0.018) although it was also found that some patients had elevated CTCs without an elevated CEA. No correlation with the time interval between detection of primary tumor and appearance of secondary (metastatic) tumor(s) was found. CTC counts did not correlate with the presence of lung or liver metastases, i.e. a number of mCRC patients with lung or liver metastases had a count of zero CTCs at baseline. We also noted no correlation between CTC number and the status of KRAS or BRAF mutation. CTC counts dropped immediately after the start of chemotherapy in 11 out of 21 patients, and also reduced from the baseline at the end of chemotherapy in 5 out of 10 patients. Six of 7 patients who started with 3 or more CTCs in 7.5 ml at baseline also showed a final CTC reduction at the end of the therapy assessment. CONCLUSIONS Analysis of circulating tumor cells may be of use in monitoring response to therapy in mCRC, either in combination with CEA monitoring or alone when CTCs are elevated but CEA level is not.
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Affiliation(s)
- Avisnata Das
- a Hematology/Oncology Division; Penn State Hershey Cancer Institute ; Hershey , PA , USA
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5
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Effects of surgery on the cancer stem cell niche. Eur J Surg Oncol 2016; 42:319-25. [DOI: 10.1016/j.ejso.2015.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 01/12/2023] Open
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6
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Allen JE, Saroya BS, Kunkel M, Dicker DT, Das A, Peters KL, Joudeh J, Zhu J, El-Deiry WS. Apoptotic circulating tumor cells (CTCs) in the peripheral blood of metastatic colorectal cancer patients are associated with liver metastasis but not CTCs. Oncotarget 2015; 5:1753-60. [PMID: 24334302 PMCID: PMC4039127 DOI: 10.18632/oncotarget.1524] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Enumeration of circulating tumor cells (CTCs) by the CellSearch system provides prognostic information in metastatic colorectal cancer, regardless of metastatic site. We found that CTCs generally represent <1% of observed events with CellSearch analysis and adapted scoring criteria to classify other peripheral blood events. Examination of twenty two metastatic colorectal cancer patients' blood revealed that patients with high CEA or liver metastases, but not lung or distant lymph node metastases, possessed significant numbers of apoptotic CTCs prior to treatment initiation by Fischer's exact test. Six out of eleven patients with liver metastasis possessed apoptotic CTCs whereas one of nine patients with other metastases had measurable apoptotic CTCs. An elevated CTC number was not necessarily associated with apoptotic CTCs or CTC debris by Spearman's correlation, suggesting the metastatic site rather than CTCs per se as contributing to the origin of these events.
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Affiliation(s)
- Joshua E Allen
- Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA
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7
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Ge F, Wang DD, Li L, Lin PP, Shuman MA. WITHDRAWN: Enhanced Detection and Phenotypic and Karyotypic in Situ Characterization of Circulating Tumor Cells. THE AMERICAN JOURNAL OF PATHOLOGY 2014:S0002-9440(14)00536-7. [PMID: 25451150 DOI: 10.1016/j.ajpath.2014.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/01/2014] [Accepted: 08/20/2014] [Indexed: 11/28/2022]
Abstract
Available online October 16, 2014 This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Feng Ge
- Department of Thoracic Surgery, Capital Medical University School of Oncology and Shi-Ji-Tan Hospital, Beijing, China
| | - Daisy D Wang
- Department of Translational Oncology, Cytelligen, San Diego, California
| | - Linda Li
- Department of Translational Oncology, Cytelligen, San Diego, California
| | - Peter P Lin
- Department of Translational Oncology, Cytelligen, San Diego, California
| | - Marc A Shuman
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco School of Medicine, San Francisco, California
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8
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The significance of circulating tumour cells in breast cancer: a review. Breast 2014; 23:552-60. [PMID: 25124235 DOI: 10.1016/j.breast.2014.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/03/2014] [Indexed: 12/15/2022] Open
Abstract
Haematogenous spread of circulating tumour cells (CTCs) is the principle mechanism for development of metastases. Research into the enumeration and characterisation of CTCs, particularly in the last decade, has allowed the introduction of semi-automated CTC assessment in the clinical setting. In breast cancer, CTC enumeration is being used as a prognostic biomarker, a predictive biomarker of treatment response and is being assessed to guide treatment in both the early and metastatic setting. CTC characterisation has the potential to direct targeted therapies, such as HER2 therapies in HER2 negative primary breast tumour patients. However, CTC assessment has considerable challenges. Capture and identification of these very rare cells is currently largely dependent on a presumed homogeneity of phenotype. In addition, high throughput assays are lacking. The clinical significance of CTCs is incompletely understood. A large proportion of CTC positive patients have no evidence of metastases, raising the issue of either inconsequential tumour dormancy or non-viable CTCs. CTCs may have additional clinical sequelae such as promoting venous thrombosis. However CTCs provide a real-time liquid biopsy of the tumour and represent an exciting, minimally invasive method of assessing disease status and also a novel therapeutic target for malignancy.
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9
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Calcein-effluxing human colon cancer cells are enriched for self-renewal capacity and depend on β-catenin. Oncotarget 2014; 4:184-91. [PMID: 23468473 PMCID: PMC3712565 DOI: 10.18632/oncotarget.883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Putative cancer stem cells are a subpopulation of cancer cells that give rise to chemotherapy resistance and are therefore of prognostic and therapeutic interest, though their identification remains elusive in colon cancer due to lack of reliable and accurate markers. We previously identified a p53-dependent putative cancer stem cell population, the calcein low population (C(lo)P), based on their exclusive efflux of the fluorescent dye Calcein. This functional identification method enables comparative live cell studies of subpopulations without differential toxicity that occurs with traditional Hoechst methods, which has confounded conclusions and limited the utility of this cancer stem cell marker. In this study, we examined the cancer stem cell-like properties of the C(lo)P population in vivo in comparison with the parental and calcein-high population (C(hi)P) in human colon cancer xenografts. Serial dilution xenograft experiments in NOD/SCID mice revealed that the C(lo)P is only marginally more tumorigenic compared to the C(hi)P or parental cells. However, serial passage of these tumors revealed that the C(lo)P is uniquely enriched for self-renewal capacity in vivo compared to the other populations. Immunohistochemical analysis of these tumors revealed that the C(lo)P possesses increased levels of nuclear β-catenin and furthermore, siRNA-mediated knockdown of β-catenin significantly reduced the C(lo)P population. These findings highlight the C(lo)P as an important subpopulation of tumor cells that are exclusively endowed with the ability to self-renew and propagate tumors. The dependency of the C(lo)P on β-catenin provides a molecular explanation for this ability and suggests that this population can and should be therapeutically targeted by inhibition of Wnt signaling.
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10
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Lim SH, Becker TM, Chua W, Caixeiro NJ, Ng WL, Kienzle N, Tognela A, Lumba S, Rasko JEJ, de Souza P, Spring KJ. Circulating tumour cells and circulating free nucleic acid as prognostic and predictive biomarkers in colorectal cancer. Cancer Lett 2013; 346:24-33. [PMID: 24368189 DOI: 10.1016/j.canlet.2013.12.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/07/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023]
Abstract
The detection of circulating tumour cells or circulating free tumour nucleic acids can potentially guide treatment and inform prognosis in colorectal cancer using minimally invasive "liquid biopsies". Current literature supports the notion that high circulating tumour cell counts or presence of tumour nucleic acid correlate with inferior clinical outcomes for patients, but they are not yet part of routine clinical care. Future research evolves around the examination of the molecular phenotype of circulating tumour cells. The key unanswered areas include differentiating between circulating tumour cell presence and their proliferative capacity and dormancy, identifying tumour heterogeneity and understanding the epithelial-mesenchymal transition.
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Affiliation(s)
- S H Lim
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia.
| | - T M Becker
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - W Chua
- Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - N J Caixeiro
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; Liverpool Clinical School, University of Western Sydney, Liverpool 2170, Australia
| | - W L Ng
- Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - N Kienzle
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - A Tognela
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; Liverpool Clinical School, University of Western Sydney, Liverpool 2170, Australia
| | - S Lumba
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - J E J Rasko
- Department of Cell and Molecular Therapies, Royal Prince Alfred Hospital, Camperdown 2050, Australia; Gene and Stem Cell Therapy Program, Centenary Institute, University of Sydney, Camperdown 2050, Australia
| | - P de Souza
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; Liverpool Clinical School, University of Western Sydney, Liverpool 2170, Australia
| | - K J Spring
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; Liverpool Clinical School, University of Western Sydney, Liverpool 2170, Australia
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Becker TM, Caixeiro NJ, Lim SH, Tognela A, Kienzle N, Scott KF, Spring KJ, de Souza P. New frontiers in circulating tumor cell analysis: A reference guide for biomolecular profiling toward translational clinical use. Int J Cancer 2013; 134:2523-33. [PMID: 24122526 DOI: 10.1002/ijc.28516] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/04/2013] [Accepted: 09/16/2013] [Indexed: 12/14/2022]
Abstract
Circulating tumor cells (CTCs) are now routinely isolated from blood, and measurement of CTC concentrations appears to correlate well with survival in patients with cancer. Interrogation of the molecular profile of CTCs for expression of protein biomarkers, genetic variants and gene expression provides opportunities to use this information to guide personalized treatment, monitor therapy and detect emerging resistance. However, successful application of profiling techniques requires analyses that deliver a reliable and clinically relevant representation of a patient's cancer as it changes with time. Here, we comprehensively review the current knowledge of therapeutically relevant biomarkers in isolated CTCs obtained by fluorescence imaging and genomic profiling approaches. The reviewed data support the notion that molecular profiling of CTCs will provide a reliable representation or surrogate index of tumor burden. Large-scale translational trials, many currently in progress, will provide critical data to progress CTC analysis toward wider clinical use in personalized treatment.
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Affiliation(s)
- Therese M Becker
- Ingham Institute for Applied Medical Research, Medical Oncology, Liverpool, New South Wales, Australia; University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
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12
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Allen JE, Gallant JN, Dicker DT, Amin S, Irby RB, Sharma AK, El-Deiry WS. The Akt inhibitor ISC-4 synergizes with cetuximab in 5-FU-resistant colon cancer. PLoS One 2013; 8:e59380. [PMID: 23555026 PMCID: PMC3595267 DOI: 10.1371/journal.pone.0059380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/13/2013] [Indexed: 01/05/2023] Open
Abstract
Phenylbutyl isoselenocyanate (ISC-4) is an Akt inhibitor with demonstrated preclinical efficacy against melanoma and colon cancer. In this study, we sought to improve the clinical utility of ISC-4 by identifying a synergistic combination with FDA-approved anti-cancer therapies, a relevant and appropriate disease setting for testing, and biomarkers of response. We tested the activity of ISC-4 and 19 FDA-approved anticancer agents, alone or in combination, against the SW480 and RKO human colon cancer cell lines. A synergistic interaction with cetuximab was identified and validated in a panel of additional colon cancer cell lines, as well as the kinetics of synergy. ISC-4 in combination with cetuximab synergistically reduced the viability of human colon cancer cells with wild-type but not mutant KRAS genes. Further analysis revealed that the combination therapy cooperatively decreased cell cycle progression, increased caspase-dependent apoptosis, and decreased phospho-Akt in responsive tumor cells. The synergism between ISC-4 and cetuximab was retained independently of acquired resistance to 5-FU in human colon cancer cells. The combination demonstrated synergistic anti-tumor effects in vivo without toxicity and in the face of resistance to 5-FU. These results suggest that combining ISC-4 and cetuximab should be explored in patients with 5-FU-resistant colon cancer harboring wild-type KRAS.
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Affiliation(s)
- Joshua E. Allen
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
| | - Jean-Nicolas Gallant
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
| | - David T. Dicker
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
| | - Shantu Amin
- Department of Pharmacology, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
| | - Rosalyn B. Irby
- Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
| | - Arun K. Sharma
- Department of Pharmacology, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
| | - Wafik S. El-Deiry
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States of America
- * E-mail:
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Resch T, Pircher A, Kähler CM, Pratschke J, Hilbe W. Endothelial progenitor cells: current issues on characterization and challenging clinical applications. Stem Cell Rev Rep 2012; 8:926-39. [PMID: 22095429 DOI: 10.1007/s12015-011-9332-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since their discovery about a decade ago, endothelial precursor cells (EPC) have been subjected to intensive investigation. The vision to stimulate respectively suppress a key player of vasculogenesis opened a plethora of clinical applications. However, as research opened deeper insights into EPC biology, the enthusiasm of the pioneer era has been damped in favour of a more critical view. Recent research is focused on three major questions: The fact that the number of EPC in peripheral blood is exceedingly low has consistently raised suspicion whether these cells can plausibly have an impact on physiological or pathophysiological processes. Secondly, whereas the key role of EPC in tumourigenesis has been strongly emphasized by various groups in the past, recent publications are challenging this hypothesis. Thirdly, the lack of consensus on EPC-defining markers and standardized protocols for their detection have repeatedly led to difficulties concerning comparability between papers. In this current review, an overview on recent findings on EPC biology is given, their challenging clinical implications are discussed and the perplexity underlying the current controversial debate is illustrated.
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Affiliation(s)
- Thomas Resch
- Center of Operative Medicine, Department of Visceral, Transplant, and Thoracic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Faltas B. Cornering metastases: therapeutic targeting of circulating tumor cells and stem cells. Front Oncol 2012; 2:68. [PMID: 22783544 PMCID: PMC3388423 DOI: 10.3389/fonc.2012.00068] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 06/12/2012] [Indexed: 12/21/2022] Open
Abstract
The last decade has witnessed an evolution of our understanding of the biology of the metastatic cascade. Recent insights into the metastatic process show that it is complex, dynamic, and multi-directional. This process starts at a very early stage in the natural history of solid tumor growth leading to early development of metastases that grow in parallel with the primary tumor. The role of stem cells in perpetuating cancer metastases is increasingly becoming more evident. At the same time, there is a growing recognition of the crucial role circulating tumor cells (CTCs) play in the development of metastases. These insights have laid the biological foundations for therapeutic targeting of CTCs, a promising area of research that aims to reduce cancer morbidity and mortality by preventing the development of metastases at a very early stage. The hematogenous transport phase of the metastatic cascade provides critical access to CTCs for therapeutic targeting aiming to interrupt the metastatic process. Recent advances in the fields of nanotechnology and microfluidics have led to the development of several devices for in vivo targeting of CTC during transit in the circulation. Selectin-coated tubes that target cell adhesion molecules, immuno-magnetic separators, and in vivo photo-acoustic flow cytometers are currently being developed for this purpose. On the pharmacological front, several pharmacological and immunological agents targeting cancer stem cells are currently being developed. Such agents may ultimately prove to be effective against circulating tumor stem cells (CTSCs). Although still in its infancy, therapeutic targeting of CTCs and CTSCs offers an unprecedented opportunity to prevent the development of metastasis and potentially alter the natural history of cancer. By rendering cancer a "local" disease, these approaches could lead to major reductions in metastasis-related morbidity and mortality.
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Affiliation(s)
- Bishoy Faltas
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
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15
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Faltas B. Circulating tumor cells in the cerebrospinal fluid: "tapping" into diagnostic and predictive potential. Oncotarget 2012; 2:822. [PMID: 22064881 PMCID: PMC3259999 DOI: 10.18632/oncotarget.349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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16
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Patel AS, Allen JE, Dicker DT, Peters KL, Sheehan JM, Glantz MJ, El-Deiry WS. Identification and enumeration of circulating tumor cells in the cerebrospinal fluid of breast cancer patients with central nervous system metastases. Oncotarget 2012; 2:752-60. [PMID: 21987585 PMCID: PMC3248154 DOI: 10.18632/oncotarget.336] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The number of circulating tumor cells (CTCs) in the peripheral blood of metastatic breast cancer patients is now an established prognostic marker. While the central nervous system is a common site of metastasis in breast cancer, the standard marker for disease progression in this setting is cerebrospinal fluid (CSF) cytology. However, the significance of CSF cytology is unclear, requires large sample size, is insensitive and subjective, and sometimes yields equivocal results. Here, we report the detection of breast cancer cells in CSF using molecular markers by adapting the CellSearch system (Veridex). We used this platform to isolate and enumerate breast cancer cells in CSF of breast cancer patients with central nervous system (CNS) metastases. The number of CSF tumor cells correlated with tumor response to chemotherapy and were dynamically associated with disease burden. This CSF tumor cell detection method provides a semi-automated molecular analysis that vastly improves the sensitivity, reliability, objectivity, and accuracy of detecting CSF tumor cells compared to CSF cytology. CSF tumor cells may serve as a marker of disease progression and early-stage brain metastasis in breast cancer and potentiate further molecular analysis to elucidate the biology and significance of tumor cells in the CSF.
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Affiliation(s)
- Akshal S Patel
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
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Iinuma H, Watanabe T, Mimori K, Adachi M, Hayashi N, Tamura J, Nozawa K, Ishihara S, Matsuda K, Fukushima R, Okinaga K, Sasako M, Mori M. Reply to B. Faltas et al. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.36.6872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hisae Iinuma
- Teikyo University School of Medicine, Tokyo, Japan
| | | | - Koshi Mimori
- Medical Institute of Bioregulation, Kyushu University, Oita, Japan
| | - Miki Adachi
- International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | | | - Junko Tamura
- Teikyo University School of Medicine, Tokyo, Japan
| | | | | | | | | | - Kota Okinaga
- Teikyo University School of Medicine, Tokyo, Japan
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