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Miyamoto DT, Ting DT, Toner M, Maheswaran S, Haber DA. Single-Cell Analysis of Circulating Tumor Cells as a Window into Tumor Heterogeneity. COLD SPRING HARBOR SYMPOSIA ON QUANTITATIVE BIOLOGY 2017; 81:269-274. [PMID: 28389596 PMCID: PMC5501288 DOI: 10.1101/sqb.2016.81.031120] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Recent advances in microfluidic approaches have enabled the efficient isolation and detailed molecular characterization of circulating tumor cells (CTCs) in the peripheral blood of patients with cancer. Single-cell molecular analyses of CTCs reveal a tremendous degree of intracellular heterogeneity in CTC populations, reflective of heterogeneity across different patients as well as the underlying heterogeneity of tumors within each individual patient. These studies have enabled the identification of heterogeneous drug resistance mechanisms that can coexist in treatment refractory tumors. CTC analyses also enable serial noninvasive monitoring in patients and can capture the emergence of tumor heterogeneity over time, whether due to tumor evolution through genetic instability or through cellular plasticity. The presence and extent of intratumoral heterogeneity as revealed through the study of CTCs have important clinical implications for understanding and predicting the development of treatment resistance in a variety of solid tumors and for formulating appropriate therapeutic strategies in the effective treatment of cancer.
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Affiliation(s)
- David T Miyamoto
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - David T Ting
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Mehmet Toner
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospitals for Children, Charlestown, Massachusetts 02129
| | - Shyamala Maheswaran
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Daniel A Haber
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
- Howard Hughes Medical Institute, Chevy Chase, Maryland 20815
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102
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Molecular heterogeneity in breast cancer: State of the science and implications for patient care. Semin Cell Dev Biol 2017; 64:65-72. [DOI: 10.1016/j.semcdb.2016.08.025] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 12/29/2022]
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103
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Bardelli A, Pantel K. Liquid Biopsies, What We Do Not Know (Yet). Cancer Cell 2017; 31:172-179. [PMID: 28196593 DOI: 10.1016/j.ccell.2017.01.002] [Citation(s) in RCA: 335] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/28/2016] [Accepted: 01/05/2017] [Indexed: 12/21/2022]
Abstract
The inherent molecular heterogeneity of metastatic tumors and the ability of cancer genomes to dynamically evolve are not properly captured by tissue specimens. Analysis of cell-free DNA and circulating tumor cells has the potential to change clinical practice by exploiting blood rather than tissue as a source of information. Liquid biopsies are already used to monitor disease response and track the emergence of drug resistance. The suitability of blood-based molecular profiles for early detection and monitoring minimal residual disease is being evaluated. In this review, we address open questions in this fast-evolving field of research.
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Affiliation(s)
- Alberto Bardelli
- University of Torino, Department of Oncology, SP 142, Km 3.95, 10060 Candiolo, Torino, Italy; Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy.
| | - Klaus Pantel
- Department of Tumor Biology, Center of Experimental Medicine, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246 Hamburg, Germany.
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104
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Leong SM, Tan KML, Chua HW, Huang MC, Cheong WC, Li MH, Tucker S, Koay ESC. Paper-Based MicroRNA Expression Profiling from Plasma and Circulating Tumor Cells. Clin Chem 2017; 63:731-741. [PMID: 28073899 DOI: 10.1373/clinchem.2016.264432] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/08/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Molecular characterization of circulating tumor cells (CTCs) holds great promise for monitoring metastatic progression and characterizing metastatic disease. However, leukocyte and red blood cell contamination of routinely isolated CTCs makes CTC-specific molecular characterization extremely challenging. METHODS Here we report the use of a paper-based medium for efficient extraction of microRNAs (miRNAs) from limited amounts of biological samples such as rare CTCs harvested from cancer patient blood. Specifically, we devised a workflow involving the use of Flinders Technology Associates (FTA)® Elute Card with a digital PCR-inspired "partitioning" method to extract and purify miRNAs from plasma and CTCs. RESULTS We demonstrated the sensitivity of this method to detect miRNA expression from as few as 3 cancer cells spiked into human blood. Using this method, background miRNA expression was excluded from contaminating blood cells, and CTC-specific miRNA expression profiles were derived from breast and colorectal cancer patients. Plasma separated out during purification of CTCs could likewise be processed using the same paper-based method for miRNA detection, thereby maximizing the amount of patient-specific information that can be derived from a single blood draw. CONCLUSIONS Overall, this paper-based extraction method enables an efficient, cost-effective workflow for maximized recovery of small RNAs from limited biological samples for downstream molecular analyses.
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Affiliation(s)
- Sai Mun Leong
- Department of Laboratory Medicine, NUH, Singapore, Singapore; .,Department of Pathology, Yong Loo Lin School of Medicine, NUS, Singapore, Singapore
| | | | - Hui Wen Chua
- Department of Pathology, Yong Loo Lin School of Medicine, NUS, Singapore, Singapore
| | - Mo-Chao Huang
- Department of Laboratory Medicine, NUH, Singapore, Singapore
| | | | | | - Steven Tucker
- Tucker Medical, Novena Specialist Center, Singapore, Singapore
| | - Evelyn Siew-Chuan Koay
- Department of Laboratory Medicine, NUH, Singapore, Singapore; .,Department of Pathology, Yong Loo Lin School of Medicine, NUS, Singapore, Singapore
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105
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Banys-Paluchowski M, Krawczyk N, Fehm T. Potential Role of Circulating Tumor Cell Detection and Monitoring in Breast Cancer: A Review of Current Evidence. Front Oncol 2016; 6:255. [PMID: 27990412 PMCID: PMC5130993 DOI: 10.3389/fonc.2016.00255] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/18/2016] [Indexed: 11/13/2022] Open
Abstract
The phenomenon of hematogenous tumor cell dissemination in patients with solid tumors has been extensively explored over the last decades. Breast cancer research investigated at first disseminated tumor cells in the bone marrow; however, the focus soon moved to circulating tumor cells (CTCs) in the peripheral blood as blood is easily accessible without an invasive procedure. The prognostic significance of CTC presence has been shown in large studies both in adjuvant and metastatic setting and commercially available detection assays have been evaluated for monitoring in clinical trials. Beyond detection and enumeration of CTCs, the characterization of single tumor cells may enhance our knowledge on disease progression and thus optimize treatment choices.
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Affiliation(s)
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, University of Duesseldorf , Duesseldorf , Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University of Duesseldorf , Duesseldorf , Germany
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106
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Hwang WL, Hwang KL, Miyamoto DT. The promise of circulating tumor cells for precision cancer therapy. Biomark Med 2016; 10:1269-1285. [PMID: 27924634 PMCID: PMC5827810 DOI: 10.2217/bmm-2016-0192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/27/2016] [Indexed: 12/20/2022] Open
Abstract
The rapidly growing array of therapeutic options in cancer requires informative biomarkers to guide the rational selection and precision application of appropriate therapies. Circulating biomarkers such as circulating tumor cells have immense potential as noninvasive, serial 'liquid biopsies' that may be more representative of the complete spectrum of a patient's individual malignancy than spatially and temporally restricted tumor biopsies. In this review, we discuss the current state-of-the-art in the isolation and molecular characterization of circulating tumor cells as well as their utility in a wide range of clinical applications such as prognostics, treatment monitoring and identification of novel therapeutic targets and resistance mechanisms to enable real-time adjustments in the clinical management of cancer.
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Affiliation(s)
- William L Hwang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Katie L Hwang
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
- Medical Scientist Training Program, Harvard Medical School, Boston, MA 02115, USA
| | - David T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
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107
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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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108
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Wang J, Bettegowda C. Applications of DNA-Based Liquid Biopsy for Central Nervous System Neoplasms. J Mol Diagn 2016; 19:24-34. [PMID: 27863260 DOI: 10.1016/j.jmoldx.2016.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/04/2016] [Accepted: 08/12/2016] [Indexed: 12/18/2022] Open
Abstract
The management of central nervous system malignancies remains reliant on histopathological analysis and neuroimaging, despite their complex genetic profile. The intratumoral heterogeneity displayed by these tumors necessitates a more sophisticated method of tumor analysis and monitoring, with the ability to assess tumors over space and time. Circulating biomarkers, including circulating tumor cells, circulating tumor DNA, and extracellular vesicles, hold promise as a type of real-time liquid biopsy able to provide dynamic information not only regarding tumor burden to monitor disease progression and treatment response, but also regarding genetic profile to enable changes in management to match a constantly evolving tumor. In numerous cancer types, including glioma, they have demonstrated their clinical utility as a minimally invasive means for diagnosis, prognostication, and prediction. In addition, they can be used in the laboratory to probe mechanisms of acquired drug resistance and tumor invasion and dissemination.
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Affiliation(s)
- Joanna Wang
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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109
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Bulfoni M, Turetta M, Del Ben F, Di Loreto C, Beltrami AP, Cesselli D. Dissecting the Heterogeneity of Circulating Tumor Cells in Metastatic Breast Cancer: Going Far Beyond the Needle in the Haystack. Int J Mol Sci 2016; 17:ijms17101775. [PMID: 27783057 PMCID: PMC5085799 DOI: 10.3390/ijms17101775] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/08/2016] [Accepted: 10/17/2016] [Indexed: 02/06/2023] Open
Abstract
Although the enumeration of circulating tumor cells (CTC) defined as expressing both epithelial cell adhesion molecule and cytokeratins (EpCAM+/CK+) can predict prognosis and response to therapy in metastatic breast, colon and prostate cancer, its clinical utility (i.e., the ability to improve patient outcome by guiding therapy) has not yet been proven in clinical trials. Therefore, scientists are now focusing on the molecular characterization of CTC as a way to explore its possible use as a “surrogate” of tumor tissues to non-invasively assess the genomic landscape of the cancer and its evolution during treatment. Additionally, evidences confirm the existence of CTC in epithelial-to-mesenchymal transition (EMT) characterized by a variable loss of epithelial markers. Since the EMT process can originate cells with enhanced invasiveness, stemness and drug-resistance, the enumeration and characterization of this population, perhaps the one truly responsible of tumor recurrence and progression, could be more clinically useful. For these reasons, several devices able to capture CTC independently from the expression of epithelial markers have been developed. In this review, we will describe the types of heterogeneity so far identified and the key role played by the epithelial-to-mesenchymal transition in driving CTC heterogeneity. The clinical relevance of detecting CTC-heterogeneity will be discussed as well.
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Affiliation(s)
- Michela Bulfoni
- Department of Medical and Biological Sciences, University of Udine, Piazzale M. Kolbe 4, 33100 Udine, Italy.
| | - Matteo Turetta
- Department of Medical and Biological Sciences, University of Udine, Piazzale M. Kolbe 4, 33100 Udine, Italy.
| | - Fabio Del Ben
- Department of Clinical Pathology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy.
| | - Carla Di Loreto
- Department of Medical and Biological Sciences, University of Udine, Piazzale M. Kolbe 4, 33100 Udine, Italy.
- Institute of Pathology, University Hospital of Udine-ASUIUD, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy.
| | - Antonio Paolo Beltrami
- Department of Medical and Biological Sciences, University of Udine, Piazzale M. Kolbe 4, 33100 Udine, Italy.
| | - Daniela Cesselli
- Department of Medical and Biological Sciences, University of Udine, Piazzale M. Kolbe 4, 33100 Udine, Italy.
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110
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Lee JS, Magbanua MJM, Park JW. Circulating tumor cells in breast cancer: applications in personalized medicine. Breast Cancer Res Treat 2016; 160:411-424. [DOI: 10.1007/s10549-016-4014-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/08/2016] [Indexed: 12/11/2022]
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111
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Beije N, Onstenk W, Kraan J, Sieuwerts AM, Hamberg P, Dirix LY, Brouwer A, de Jongh FE, Jager A, Seynaeve CM, Van NM, Foekens JA, Martens JWM, Sleijfer S. Prognostic Impact of HER2 and ER Status of Circulating Tumor Cells in Metastatic Breast Cancer Patients with a HER2-Negative Primary Tumor. Neoplasia 2016; 18:647-653. [PMID: 27764697 PMCID: PMC5071539 DOI: 10.1016/j.neo.2016.08.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preclinical and clinical studies have reported that human epidermal growth factor receptor 2 (HER2) overexpression yields resistance to endocrine therapies. Here the prevalence and prognostic impact of HER2-positive circulating tumor cells (CTCs) were investigated retrospectively in metastatic breast cancer (MBC) patients with a HER2-negative primary tumor receiving endocrine therapy. Additionally, the prevalence and prognostic significance of HER2-positive CTCs were explored in a chemotherapy cohort, as well as the prognostic impact of the estrogen receptor (ER) CTC status in both cohorts. METHODS Included were MBC patients with a HER2-negative primary tumor, with ≥1 detectable CTC, starting a new line of treatment. CTCs were enumerated using the CellSearch system, characterized for HER2 with the CellSearch anti-HER2 phenotyping reagent, and characterized for ER mRNA expression. Primary end point was progression-free rate after 6 months (PFR6months) of endocrine treatment in HER2-positive versus HER2-negative CTC patients. RESULTS HER2-positive CTCs were present in 29% of all patients. In the endocrine cohort (n=72), the PFR6months was 53% for HER2-positive versus 68% for HER2-negative CTC patients (P=.23). In the chemotherapy cohort (n=82), no prognostic value of HER2-positive CTCs on PFR6months was observed either. Discordances in ER status between the primary tumor and CTCs occurred in 25% of all patients but had no prognostic value in exploratory survival analyses. CONCLUSION Discordances regarding HER2 status and ER status between CTCs and the primary tumor occurred frequently but had no prognostic impact in our MBC patient cohorts.
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Affiliation(s)
- Nick Beije
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Wendy Onstenk
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Jaco Kraan
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Anieta M Sieuwerts
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Paul Hamberg
- Franciscus Gasthuis, Department of Internal Medicine, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Luc Y Dirix
- Oncology Center GZA Hospitals Sint Augustinus, Translational Cancer Research Unit, Department of Medical Oncology, Oosterveldlaan 26, 2610, Antwerp, Belgium
| | - Anja Brouwer
- Oncology Center GZA Hospitals Sint Augustinus, Translational Cancer Research Unit, Department of Medical Oncology, Oosterveldlaan 26, 2610, Antwerp, Belgium
| | - Felix E de Jongh
- Ikazia Hospital, Department of Internal Medicine, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands
| | - Agnes Jager
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Caroline M Seynaeve
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Ngoc M Van
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - John A Foekens
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - John W M Martens
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Department of Medical Oncology and Cancer Genomics Netherlands, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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112
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Impact of apoptotic circulating tumor cells (aCTC) in metastatic breast cancer. Breast Cancer Res Treat 2016; 160:277-290. [DOI: 10.1007/s10549-016-3997-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/20/2016] [Indexed: 01/09/2023]
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113
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Hernández-Blanquisett A, Touya D, Strasser-Weippl K, Ruiz R, St. Louis J, Goss P. Current and emerging therapies of HER2-positive metastatic breast cancer. Breast 2016; 29:170-7. [DOI: 10.1016/j.breast.2016.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/18/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
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114
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Murray NP, Reyes E, Fuentealba C, Jacob O, Orellana N. Possible Role of HER-2 in the Progression of Prostate Cancer from Primary Tumor to Androgen Independence. Asian Pac J Cancer Prev 2016; 16:6615-9. [PMID: 26434884 DOI: 10.7314/apjcp.2015.16.15.6615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The expression of HER-2 in prostate cancer has been linked to disease progression. We analysed the presence of HER-2 expression in primary tumors in men undergoing radical prostatectomy, its association with clinical and pathological findings, and its expression in secondary circulating prostate cells (CPCs) during follow up, as well as links with biochemical failure and the effects of androgen blockade. MATERIALS AND METHODS Consecutive men undergoing radical prostatectomy for histologically confirmed prostate cancer were analyzed. HER-2 expression in the primary tumor was assessed using the HercepTest®, CPCs were identified from blood samples using standard immunocytochemistry with anti-PSA and positive samples with the HercepTest® to determine HER-2 expression. The influence of HER-2 expression on the frequency of biochemical failure and effects of androgen blockade was determined. RESULTS 144 men with a mean age of 64.8±10.3 years participated, with a median follow up of 8.2 years. HER-2 was expressed in 20.8% of primary tumors; it was associated with vascular infiltration and older age, but not with other clinical pathological findings. Some 40.3% of men had secondary CPCs detected, of which 38% expressed HER-2. Men CPC (+) had a higher frequency of biochemical failure, but there was no difference in HER-2 expression of CPCs with the frequency of biochemical failure. After androgen blockade, men with HER-2 (+) positive secondary CPCs had a higher frequency of disease progression to castrate resistant disease. CONCLUSIONS HER-2 plays a dual role in the progression of prostate cancer; firstly it may increase the potential of tumor cells to disseminate from the primary tumor via the blood by increasing vascular infiltration. In the presence of androgens, there is no survival advantage of expressing HER-2, but once biochemical failure has occurred and androgen blockade started, HER-2 positive cells are resistant to treatment, survive and grow leading to castration resistant disease.
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Affiliation(s)
- Nigel P Murray
- Hematology, Medicine, Hospital de Carabineros de Chile, Faculty of Medicine University Finis Terrae, Santiago, Chile E-mail :
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115
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Frequent detection of PIK3CA mutations in single circulating tumor cells of patients suffering from HER2-negative metastatic breast cancer. Mol Oncol 2016; 10:1330-43. [PMID: 27491860 DOI: 10.1016/j.molonc.2016.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/27/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
Modern technologies enable detection and characterization of circulating tumor cells (CTC) in peripheral blood samples. Thus, CTC have attracted interest as markers for therapeutic response in breast cancer. First studies have incorporated CTC analyses to guide therapeutic interventions and stratification of breast cancer patients. Aim of this study was to analyze characteristic features of CTC as biomarker for predicting resistance to HER2-targeted therapies. Therefore, CTC from metastatic breast cancer patients with HER2-negative primary tumors screened for the prospective randomized phase III trial DETECT III were explored for their HER2 status and the presence of PIK3CA mutations. Detection and characterization of HER2 expression of CTC were conducted with the CellSearch(®) system. Fifteen of 179 CTC-positive patients (8.4%) contained ≥1 CTC with strong HER2 expression. Genomic DNA from individual CTC isolated by micromanipulation was propagated by whole genome amplification and analyzed for PIK3CA mutations in exons 9 and 20 by Sanger sequencing. One or more CTC/7.5 mL were detected in 179/290 patients (61.7%). In 109 patients (34.8%), ≥5 CTC/7.5 mL were found. We detected at least one CTC with the mutation p.E542K, p.E545K, p.H1047R, p.H1047L or p.M1043V in 12/33 patients (36.4%). Thirty six of 114 CTC (31.6%) harbored one of these mutations. CTC in individual patients exhibited heterogeneity concerning PIK3CA mutations and HER2 expression. In conclusion, clinically relevant genomic aberrations such as mutations in the hotspot regions of exon 9 and 20 of the PIK3CA gene can be detected in single CTC and might provide insights into mechanisms of resistance to HER2-targeted therapies.
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116
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Mego M, Gao H, Cohen EN, Anfossi S, Giordano A, Sanda T, Fouad TM, De Giorgi U, Giuliano M, Woodward WA, Alvarez RH, Valero V, Ueno NT, Hortobagyi GN, Cristofanilli M, Reuben JM. Circulating Tumor Cells (CTC) Are Associated with Defects in Adaptive Immunity in Patients with Inflammatory Breast Cancer. J Cancer 2016; 7:1095-104. [PMID: 27326253 PMCID: PMC4911877 DOI: 10.7150/jca.13098] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/07/2015] [Indexed: 01/15/2023] Open
Abstract
Background: Circulating tumor cells (CTCs) play a crucial role in tumor dissemination and are prognostic in primary and metastatic breast cancer. Peripheral blood (PB) immune cells contribute to an unfavorable microenvironment for CTC survival. This study aimed to correlate CTCs with the PB T-cell immunophenotypes and functions of patients with inflammatory breast cancer (IBC). Methods: This study included 65 IBC patients treated at the MD Anderson Cancer Center. PB was obtained from patients prior to starting a new line of chemotherapy for CTCs enumeration by CellSearch®, and T cell phenotype and function by flow cytometry; the results were correlated with CTCs and clinical outcome. Results: At least 1 CTC (≥1) or ≥5 CTCs was detected in 61.5% or 32.3% of patients, respectively. CTC count did not correlate with total lymphocytes; however, patients with ≥1 CTC or ≥5 CTCs had lower percentages (%) of CD3+ and CD4+ T cells compared with patients with no CTCs or <5 CTCs, respectively. Patients with ≥1 CTC had a lower percentage of T-cell receptor (TCR)-activated CD8+ T cells synthesizing TNF-α and IFN-γ and a higher percentage of T-regulatory lymphocytes compared to patients without CTCs. In multivariate analysis, tumor grade and % CD3+ T-cells were associated with ≥1 CTC, whereas ≥5 CTC was associated with tumor grade, stage, % CD3+ and % CD4+ T cells, and % TCR-activated CD8 T-cells synthesizing IL-17. Conclusions: IBC patients with CTCs in PB had abnormalities in adaptive immunity that could potentially impact tumor cell dissemination and initiation of the metastatic cascade.
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Affiliation(s)
- M Mego
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 5. Currently at 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - H Gao
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - E N Cohen
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - S Anfossi
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Giordano
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - T Sanda
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - T M Fouad
- 2. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - U De Giorgi
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 6. Currently at Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola (FC), Italy
| | - M Giuliano
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 7. Currently at Department of Clinical Medicine and Surgery, University Federico II, Naples. Italy
| | - W A Woodward
- 3. Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - R H Alvarez
- 2. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 4. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 8. Currently at Cancer Treatment Centers of America, Newnan, GA, USA
| | - V Valero
- 2. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 4. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - N T Ueno
- 2. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 4. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - G N Hortobagyi
- 2. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - M Cristofanilli
- 2. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 9. Currently at Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA, USA
| | - J M Reuben
- 1. Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;; 4. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Tachtsidis A, McInnes LM, Jacobsen N, Thompson EW, Saunders CM. Minimal residual disease in breast cancer: an overview of circulating and disseminated tumour cells. Clin Exp Metastasis 2016; 33:521-50. [PMID: 27189371 PMCID: PMC4947105 DOI: 10.1007/s10585-016-9796-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/22/2016] [Indexed: 12/11/2022]
Abstract
Within the field of cancer research, focus on the study of minimal residual disease (MRD) in the context of carcinoma has grown exponentially over the past several years. MRD encompasses circulating tumour cells (CTCs)—cancer cells on the move via the circulatory or lymphatic system, disseminated tumour cells (DTCs)—cancer cells which have escaped into a distant site (most studies have focused on bone marrow), and resistant cancer cells surviving therapy—be they local or distant, all of which may ultimately give rise to local relapse or overt metastasis. Initial studies simply recorded the presence and number of CTCs and DTCs; however recent advances are allowing assessment of the relationship between their persistence, patient prognosis and the biological properties of MRD, leading to a better understanding of the metastatic process. Technological developments for the isolation and analysis of circulating and disseminated tumour cells continue to emerge, creating new opportunities to monitor disease progression and perhaps alter disease outcome. This review outlines our knowledge to date on both measurement and categorisation of MRD in the form of CTCs and DTCs with respect to how this relates to cancer outcomes, and the hurdles and future of research into both CTCs and DTCs.
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Affiliation(s)
- A Tachtsidis
- St. Vincent's Institute, Melbourne, VIC, Australia
- University of Melbourne, Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - L M McInnes
- School of Surgery, The University of Western Australia, Perth, WA, Australia
| | - N Jacobsen
- School of Surgery, The University of Western Australia, Perth, WA, Australia
| | - E W Thompson
- University of Melbourne, Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Translational Research Institute, Woolloongabba, QLD, Australia
| | - C M Saunders
- School of Surgery, The University of Western Australia, Perth, WA, Australia.
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Blassl C, Kuhlmann JD, Webers A, Wimberger P, Fehm T, Neubauer H. Gene expression profiling of single circulating tumor cells in ovarian cancer - Establishment of a multi-marker gene panel. Mol Oncol 2016; 10:1030-42. [PMID: 27157930 DOI: 10.1016/j.molonc.2016.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 12/19/2022] Open
Abstract
The presence of circulating tumor cells (CTCs) in the blood of ovarian cancer patients was shown to correlate with decreased overall survival, whereby CTCs with epithelial-mesenchymal-transition (EMT) or stem-like traits are supposed to be involved in metastatic progression and recurrence. Thus, investigating the transcriptional profiles of CTCs might help to identify therapy resistant tumor cells and to overcome treatment failure. For this purpose, we established a multi-marker panel for the molecular characterization of single CTCs, detecting epithelial (EpCAM, Muc-1, CK5/7), EMT (N-cadherin, Vimentin, Snai1/2, CD117, CD146, CD49f) and stem cell (CD44, ALDH1A1, Nanog, SOX2, Notch1/4, Oct4, Lin28) associated transcripts. First primer specificity and PCR-performance of the multiplex-RT-PCRs were successfully validated on genomic DNA and cDNA isolated from OvCar3 cells. The assay sensitivity of the epithelial panel was evaluated by adding defined numbers of tumor cells into the blood of healthy donors and performing a subsequent immunomagnetic tumor cell enrichment (AdnaTest OvarianCancerSelect), resulting in a 100% concordance for the epithelial markers EpCAM and Muc-1 to the AdnaTest OvarianCancerDetect. Additionally, by processing blood from ovarian cancer patients, high assay sensitivity could be verified. In blood of healthy donors no signals for epithelial markers were detected, for EMT and stem cell markers, however, signals were obtained mainly originating from leukocytes which calls for single cell analysis. To that aim by using the ovarian cancer cell line OvCar3, we successfully established a workflow enabling the characterization of single CTCs. It consists of a density gradient-dependent enrichment for nucleated cells, a depletion of CD45-positive cells of hematopoietic origin followed by immunofluorescent labeling of CTCs by EpCAM and Muc-1. Single CTCs are then isolated by micromanipulation and processed for panel gene expression profiling. Finally, fifteen single CTCs from three ovarian cancer patients were analyzed and found to be positive for stem cell (CD44, ALDH1A1, Nanog, Oct4) and EMT markers (N-cadherin, Vimentin, Snai2, CD117, CD146). Albeit, inter-cellular and intra/inter-patient heterogeneity and co-expression of epithelial, mesenchymal and stem cell transcripts on the same CTC was observed. We have established a robust workflow to perform sensitive single cell panel gene expression analysis without the need of pre-amplification steps. Our data point towards a heterogeneous expression of stem cell and EMT associated transcripts in ovarian cancer CTCs.
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Affiliation(s)
- Christina Blassl
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University Duesseldorf, Life Science Center, Merowingerplatz 1A, 40225 Duesseldorf, Germany.
| | - Jan Dominik Kuhlmann
- Department of Obstetrics and Gynecology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Alessandra Webers
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University Duesseldorf, Life Science Center, Merowingerplatz 1A, 40225 Duesseldorf, Germany.
| | - Pauline Wimberger
- Department of Obstetrics and Gynecology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany.
| | - Hans Neubauer
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University Duesseldorf, Life Science Center, Merowingerplatz 1A, 40225 Duesseldorf, Germany.
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Alix-Panabières C, Pantel K. Clinical Applications of Circulating Tumor Cells and Circulating Tumor DNA as Liquid Biopsy. Cancer Discov 2016; 6:479-91. [PMID: 26969689 DOI: 10.1158/2159-8290.cd-15-1483] [Citation(s) in RCA: 919] [Impact Index Per Article: 114.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/18/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED "Liquid biopsy" focusing on the analysis of circulating tumor cells (CTC) and circulating cell-free tumor DNA (ctDNA) in the blood of patients with cancer has received enormous attention because of its obvious clinical implications for personalized medicine. Analyses of CTCs and ctDNA have paved new diagnostic avenues and are, to date, the cornerstones of liquid biopsy diagnostics. The present review focuses on key areas of clinical applications of CTCs and ctDNA, including detection of cancer, prediction of prognosis in patients with curable disease, monitoring systemic therapies, and stratification of patients based on the detection of therapeutic targets or resistance mechanisms. SIGNIFICANCE The application of CTCs and ctDNA for the early detection of cancer is of high public interest, but it faces serious challenges regarding specificity and sensitivity of the current assays. Prediction of prognosis in patients with curable disease can already be achieved in several tumor entities, particularly in breast cancer. Monitoring the success or failure of systemic therapies (i.e., chemotherapy, hormonal therapy, or other targeted therapies) by sequential measurements of CTCs or ctDNA is also feasible. Interventional studies on treatment stratification based on the analysis of CTCs and ctDNA are needed to implement liquid biopsy into personalized medicine. Cancer Discov; 6(5); 479-91. ©2016 AACR.
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Affiliation(s)
- Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells (LCCRH), Department of Cellular and Tissular Biopathology of Tumors, University Medical Centre, Montpellier, France. EA2415 - Help for Personalized Decision, Methodological Aspects, University Institute of Clinical Research (IURC), Montpellier University, Montpellier, France
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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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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Rack B, Zombirt E, Trapp E, Jückstock J, Andergassen U, Neugebauer J, Kost B, Weissenbacher T, Jeschke U, Schindlbeck C, Janni W, Alunni-Fabbroni M. Comparison of HER2 Expression in Primary Tumor and Disseminated Tumor Cells in the Bone Marrow of Breast Cancer Patients. Oncology 2016; 90:232-8. [PMID: 26937631 DOI: 10.1159/000442986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to measure the human epidermal growth factor receptor 2 (HER2) status of disseminated tumor cells (DTCs) from bone marrow (BM) aspirates and to assess correspondence or discrepancy with the primary tumor. METHODS DTCs were isolated from the BM of 156 breast cancer patients. Cytokeratin-positive DTCs were further analyzed by the chromogenic in situ hybridization method to detect HER2 gene amplification. RESULTS A significant correlation (p = 0.021) was found between the HER2 status of DTCs and the primary tumors. Sixty-one (68.5%) patients had a corresponding status. However, a shift of phenotype between primary tumor and DTCs was found in the remaining patients. CONCLUSION This study showed a significant grade of discordance of the HER2 status between primary tumors and DTCs in the BM of a relevant subgroup of patients. Detection of HER2 amplification on DTCs could therefore help to better stratify patients for a more tailored therapy, since they would benefit from a HER2-targeted therapy.
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Affiliation(s)
- Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig Maximilians University, Munich, Germany
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Sensitive and Specific Biomimetic Lipid Coated Microfluidics to Isolate Viable Circulating Tumor Cells and Microemboli for Cancer Detection. PLoS One 2016; 11:e0149633. [PMID: 26938471 PMCID: PMC4777486 DOI: 10.1371/journal.pone.0149633] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022] Open
Abstract
Here we presented a simple and effective membrane mimetic microfluidic device with antibody conjugated supported lipid bilayer (SLB) "smart coating" to capture viable circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) directly from whole blood of all stage clinical cancer patients. The non-covalently bound SLB was able to promote dynamic clustering of lipid-tethered antibodies to CTC antigens and minimized non-specific blood cells retention through its non-fouling nature. A gentle flow further flushed away loosely-bound blood cells to achieve high purity of CTCs, and a stream of air foam injected disintegrate the SLB assemblies to release intact and viable CTCs from the chip. Human blood spiked cancer cell line test showed the ~95% overall efficiency to recover both CTCs and CTMs. Live/dead assay showed that at least 86% of recovered cells maintain viability. By using 2 mL of peripheral blood, the CTCs and CTMs counts of 63 healthy and colorectal cancer donors were positively correlated with the cancer progression. In summary, a simple and effective strategy utilizing biomimetic principle was developed to retrieve viable CTCs for enumeration, molecular analysis, as well as ex vivo culture over weeks. Due to the high sensitivity and specificity, it is the first time to show the high detection rates and quantity of CTCs in non-metastatic cancer patients. This work offers the values in both early cancer detection and prognosis of CTC and provides an accurate non-invasive strategy for routine clinical investigation on CTCs.
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Krawczyk N, Fehm T, Banys-Paluchowski M, Janni W, Schramm A. Liquid Biopsy in Metastasized Breast Cancer as Basis for Treatment Decisions. Oncol Res Treat 2016; 39:112-6. [DOI: 10.1159/000444605] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/10/2016] [Indexed: 11/19/2022]
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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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Masuda T, Hayashi N, Iguchi T, Ito S, Eguchi H, Mimori K. Clinical and biological significance of circulating tumor cells in cancer. Mol Oncol 2016; 10:408-17. [PMID: 26899533 DOI: 10.1016/j.molonc.2016.01.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 02/08/2023] Open
Abstract
During the process of metastasis, which is the leading cause of cancer-related death, cancer cells dissociate from primary tumors, migrate to distal sites, and finally colonize, eventually leading to the formation of metastatic tumors. The migrating tumor cells in circulation, e.g., those found in peripheral blood (PB) or bone marrow (BM), are called circulating tumor cells (CTCs). CTCs in the BM are generally called disseminated tumor cells (DTCs). Many studies have reported the detection and characterization of CTCs to facilitate early diagnosis of relapse or metastasis and improve early detection and appropriate treatment decisions. Initially, epithelial markers, such as EpCAM and cytokeratins (CKs), identified using immunocytochemistry or reverse transcription polymerase chain reaction (RT-PCR) were used to identify CTCs in PB or BM. Recently, however, other markers such as human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and immuno-checkpoint genes also have been examined to facilitate detection of CTCs with metastatic potential. Moreover, the epithelial-to-mesenchymal transition (EMT) and cancer stem cells (CSCs) have also received increasing attention as important CTC markers owing to their roles in the biological progression of metastasis. In addition to these markers, researchers have attempted to develop detection or capture techniques for CTCs. Notably, however, the establishment of metastasis requires cancer-host interactions. Markers from host cells, such as macrophages, mesenchymal stem cells, and bone marrow-derived cells, which constitute the premetastatic niche, may become novel biomarkers for predicting relapse or metastasis or monitoring the effects of treatment. Biological studies of CTCs are still emerging. However, recent technical innovations, such as next-generation sequencing, are being used more commonly and could help to clarify the mechanism of metastasis. Additionally, biological findings are gradually being accumulated, adding to our body of knowledge on CTCs. In this review, we will summarize recent approaches to detect or capture CTCs. Moreover, we will introduce recent studies of the clinical and biological importance of CTCs and host cells.
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Affiliation(s)
- Takaaki Masuda
- Kyushu University Beppu Hospital, Department of Surgery, Japan
| | - Naoki Hayashi
- Kyushu University Beppu Hospital, Department of Surgery, Japan
| | - Tomohiro Iguchi
- Kyushu University Beppu Hospital, Department of Surgery, Japan
| | - Shuhei Ito
- Kyushu University Beppu Hospital, Department of Surgery, Japan
| | | | - Koshi Mimori
- Kyushu University Beppu Hospital, Department of Surgery, Japan.
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Lianidou ES. Gene expression profiling and DNA methylation analyses of CTCs. Mol Oncol 2016; 10:431-42. [PMID: 26880168 DOI: 10.1016/j.molonc.2016.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 01/26/2023] Open
Abstract
A variety of molecular assays have been developed for CTCs detection and molecular characterization. Molecular assays are based on the nucleic acid analysis in CTCs and are based on total RNA isolation and subsequent mRNA quantification of specific genes, or isolation of genomic DNA that can be for DNA methylation studies and mutation analysis. This review is mainly focused on gene expression and methylation studies in CTCs in various types of cancer.
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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, Greece.
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127
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Disseminated and circulating tumor cells in bone marrow and blood of breast cancer patients: properties, enrichment, and potential targets. J Cancer Res Clin Oncol 2016; 142:1883-95. [DOI: 10.1007/s00432-016-2118-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/18/2016] [Indexed: 02/03/2023]
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Janni WJ, Rack B, Terstappen LWMM, Pierga JY, Taran FA, Fehm T, Hall C, de Groot MR, Bidard FC, Friedl TWP, Fasching PA, Brucker SY, Pantel K, Lucci A. Pooled Analysis of the Prognostic Relevance of Circulating Tumor Cells in Primary Breast Cancer. Clin Cancer Res 2016; 22:2583-93. [PMID: 26733614 DOI: 10.1158/1078-0432.ccr-15-1603] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Although unequivocal evidence has shown the prognostic relevance of circulating tumor cells (CTC) in the peripheral blood of patients with metastatic breast cancer, less evidence is available for the prognostic relevance of CTCs at the time of primary diagnosis. EXPERIMENTAL DESIGN We conducted a pooled analysis of individual data from 3,173 patients with nonmetastatic (stage I-III) breast cancer from five breast cancer institutions. The prevalence and numbers of CTCs were assessed at the time of primary diagnosis with the FDA-cleared CellSearch System (Janssen Diagnostics, LLC). Patient outcomes were analyzed using meta-analytic procedures, univariate log-rank tests, and multivariate Cox proportional hazard regression analyses. The median follow-up duration was 62.8 months. RESULTS One or more CTCs were detected in 20.2% of the patients. CTC-positive patients had larger tumors, increased lymph node involvement, and a higher histologic tumor grade than did CTC-negative patients (all P < 0.002). Multivariate Cox regressions, which included tumor size, nodal status, histologic tumor grade, and hormone receptor and HER2 status, confirmed that the presence of CTCs was an independent prognostic factor for disease-free survival [HR, 1.82; 95% confidence interval (CI), 1.47-2.26], distant disease-free survival (HR, 1.89; 95% CI, 1.49-2.40), breast cancer-specific survival (HR, 2.04; 95% CI, 1.52-2.75), and overall survival (HR, 1.97; 95% CI, 1.51-2.59). CONCLUSIONS In patients with primary breast cancer, the presence of CTCs was an independent predictor of poor disease-free, overall, breast cancer-specific, and distant disease-free survival. Clin Cancer Res; 22(10); 2583-93. ©2016 AACR.
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Affiliation(s)
- Wolfgang J Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Descartes, Paris, France
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Carolyn Hall
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anthony Lucci
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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129
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Sirkisoon SR, Carpenter RL, Rimkus T, Miller L, Metheny-Barlow L, Lo HW. EGFR and HER2 signaling in breast cancer brain metastasis. Front Biosci (Elite Ed) 2016; 8:245-63. [PMID: 26709660 DOI: 10.2741/e765] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Breast cancer occurs in approximately 1 in 8 women and 1 in 37 women with breast cancer succumbed to the disease. Over the past decades, new diagnostic tools and treatments have substantially improved the prognosis of women with local diseases. However, women with metastatic disease still have a dismal prognosis without effective treatments. Among different molecular subtypes of breast cancer, the HER2-enriched and basal-like subtypes typically have higher rates of metastasis to the brain. Basal-like metastatic breast tumors frequently express EGFR. Consequently, HER2- and EGFR-targeted therapies are being used in the clinic and/or evaluated in clinical trials for treating breast cancer patients with brain metastases. In this review, we will first provide an overview of the HER2 and EGFR signaling pathways. The roles that EGFR and HER2 play in breast cancer metastasis to the brain will then be discussed. Finally, we will summarize the preclinical and clinical effects of EGFR- and HER2-targeted therapies on breast cancer metastasis.
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Affiliation(s)
- Sherona R Sirkisoon
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC27157
| | - Richard L Carpenter
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC27157
| | - Tadas Rimkus
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC27157
| | - Lance Miller
- Department of Breast Cancer Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC27157, Wake Forest University School of Medicine, Winston-Salem, NC27157
| | - Linda Metheny-Barlow
- Department of Breast Cancer Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC27157, Wake Forest University School of Medicine, Winston-Salem, NC27157
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27157,
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130
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Stoecklein NH, Fischer JC, Niederacher D, Terstappen LWMM. Challenges for CTC-based liquid biopsies: low CTC frequency and diagnostic leukapheresis as a potential solution. Expert Rev Mol Diagn 2015; 16:147-64. [DOI: 10.1586/14737159.2016.1123095] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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131
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Alberter B, Klein CA, Polzer B. Single-cell analysis of CTCs with diagnostic precision: opportunities and challenges for personalized medicine. Expert Rev Mol Diagn 2015; 16:25-38. [PMID: 26567956 DOI: 10.1586/14737159.2016.1121099] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The generation of variant cancer cells is the major cause of acquired resistance against systemic therapies and consequently, of our inability to cure advanced cancer patients. Circulating tumor cells are gaining increasing clinical attention because they may enable the monitoring cancer progression and adjustment of treatment. In recent years multiple technologies for enrichment, isolation as well as molecular and functional analysis of circulating tumor cells have been developed. Implementation of these technologies in standardized and automated workflows in clinical diagnostics could provide valuable information for real-time monitoring of cancer and eventually new therapeutic strategies for the benefit of patients.
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Affiliation(s)
- Barbara Alberter
- a Project Group "Personalized Tumor Therapy" , Fraunhofer Institute for Toxicology and Experimental Medicine , Regensburg , Germany
| | - Christoph A Klein
- a Project Group "Personalized Tumor Therapy" , Fraunhofer Institute for Toxicology and Experimental Medicine , Regensburg , Germany.,b Experimental Medicine and Therapy Research , University of Regensburg , Regensburg , Germany
| | - Bernhard Polzer
- a Project Group "Personalized Tumor Therapy" , Fraunhofer Institute for Toxicology and Experimental Medicine , Regensburg , Germany
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132
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Appert-Collin A, Hubert P, Crémel G, Bennasroune A. Role of ErbB Receptors in Cancer Cell Migration and Invasion. Front Pharmacol 2015; 6:283. [PMID: 26635612 PMCID: PMC4657385 DOI: 10.3389/fphar.2015.00283] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/10/2015] [Indexed: 01/01/2023] Open
Abstract
Growth factors mediate their diverse biologic responses (regulation of cellular proliferation, differentiation, migration and survival) by binding to and activating cell-surface receptors with intrinsic protein kinase activity named receptor tyrosine kinases (RTKs). About 60 RTKs have been identified and can be classified into more than 16 different receptor families. Their activity is normally tightly controlled and regulated. Overexpression of RTK proteins or functional alterations caused by mutations in the corresponding genes or abnormal stimulation by autocrine growth factor loops contribute to constitutive RTK signaling, resulting in alterations in the physiological activities of cells. The ErbB receptor family of RTKs comprises four distinct receptors: the EGFR (also known as ErbB1/HER1), ErbB2 (neu, HER2), ErbB3 (HER3) and ErbB4 (HER4). ErbB family members are often overexpressed, amplified, or mutated in many forms of cancer, making them important therapeutic targets. EGFR has been found to be amplified in gliomas and non-small-cell lung carcinoma while ErbB2 amplifications are seen in breast, ovarian, bladder, non-small-cell lung carcinoma, as well as several other tumor types. Several data have shown that ErbB receptor family and its downstream pathway regulate epithelial-mesenchymal transition, migration, and tumor invasion by modulating extracellular matrix (ECM) components. Recent findings indicate that ECM components such as matrikines bind specifically to EGF receptor and promote cell invasion. In this review, we will present an in-depth overview of the structure, mechanisms, cell signaling, and functions of ErbB family receptors in cell adhesion and migration. Furthermore, we will describe in a last part the new strategies developed in anti-cancer therapy to inhibit ErbB family receptor activation.
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Affiliation(s)
- Aline Appert-Collin
- UMR CNRS 7369, Unité Matrice Extracellulaire et Dynamique Cellulaire, Université de Reims Champagne-Ardenne Reims, France
| | - Pierre Hubert
- Laboratoire d'Ingénierie des Systèmes Macromoléculaires, CNRS-AMU UMR 7255 Marseille, France
| | | | - Amar Bennasroune
- UMR CNRS 7369, Unité Matrice Extracellulaire et Dynamique Cellulaire, Université de Reims Champagne-Ardenne Reims, France ; UMR CNRS 7360, Laboratoire Interdisciplinaire des Environnements Continentaux, Université de Lorraine Metz, France
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133
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Circulating tumor cells in breast cancer--current status and perspectives. Crit Rev Oncol Hematol 2015; 97:22-9. [PMID: 26563820 DOI: 10.1016/j.critrevonc.2015.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/12/2015] [Accepted: 10/27/2015] [Indexed: 12/15/2022] Open
Abstract
The phenomenon of tumor cell dissemination through the blood stream has been known since the 19th century. Circulating tumor cells (CTCs) may be detected in peripheral blood of patients with breast cancer and may serve as a surrogate marker for minimal residual disease. Prognostic relevance of CTCs has already been demonstrated in early and metastatic breast cancer and commercially available detection systems are currently employed in various clinical trials. Since peripheral blood is an easily accessible compartment, serial reevaluation of CTCs is possible and may contribute to better therapy monitoring. Another potential of CTCs lies in the characterization of tumor cells. Expression profiles may differ between CTCs and primary tumor, which may result in different responses to treatment. Assessment of molecular features of CTCs may be an important step for the optimization of adjuvant and metastatic systemic therapy.
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134
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Pixberg CF, Schulz WA, Stoecklein NH, Neves RPL. Characterization of DNA Methylation in Circulating Tumor Cells. Genes (Basel) 2015; 6:1053-75. [PMID: 26506390 PMCID: PMC4690028 DOI: 10.3390/genes6041053] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 02/07/2023] Open
Abstract
Epigenetics contributes to molecular mechanisms leading to tumor cell transformation and systemic progression of cancer. However, the dynamics of epigenetic remodeling during metastasis remains unexplored. In this context, circulating tumor cells (CTCs) might enable a direct insight into epigenetic mechanisms relevant for metastasis by providing direct access to systemic cancer. CTCs can be used as prognostic markers in cancer patients and are regarded as potential metastatic precursor cells. However, despite substantial technical progress, the detection and molecular characterization of CTCs remain challenging, in particular the analysis of DNA methylation. As recent studies have started to address the epigenetic state of CTCs, we discuss here the potential of such investigations to elucidate mechanisms of metastasis and to develop tumor biomarkers.
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Affiliation(s)
- Constantin F Pixberg
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Wolfgang A Schulz
- Department of Urology, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany.
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Rui P L Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
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135
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Abstract
Circulating tumor cells (CTCs) are a population of tumor cells mediating metastasis, which results in most of the cancer related deaths. The number of CTCs in the peripheral blood of patients is rare, and many platforms have been launched for detection and enrichment of CTCs. Enumeration of CTCs has already been used as a prognosis marker predicting the survival rate of cancer patients. Yet CTCs should be more potential. Studies on CTCs at single cell level may help revealing the underlying mechanism of tumorigenesis and metastasis. Though far from developed, this area of study holds much promise in providing new clinical application and deep understanding towards metastasis and cancer development.
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Affiliation(s)
- Xi-Xi Chen
- Biodynamic Optical Imaging Center, School of Life Science, Peking University, Beijing 100871, China
| | - Fan Bai
- Biodynamic Optical Imaging Center, School of Life Science, Peking University, Beijing 100871, China
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136
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Therapeutic intervention based on circulating tumor cell phenotype in metastatic breast cancer: concept of the DETECT study program. Arch Gynecol Obstet 2015; 293:271-81. [DOI: 10.1007/s00404-015-3879-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/26/2015] [Indexed: 12/18/2022]
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137
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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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138
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Dent BM, Ogle LF, O'Donnell RL, Hayes N, Malik U, Curtin NJ, Boddy AV, Plummer ER, Edmondson RJ, Reeves HL, May FEB, Jamieson D. High-resolution imaging for the detection and characterisation of circulating tumour cells from patients with oesophageal, hepatocellular, thyroid and ovarian cancers. Int J Cancer 2015; 138:206-16. [PMID: 26178530 PMCID: PMC4737101 DOI: 10.1002/ijc.29680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 06/09/2015] [Indexed: 12/11/2022]
Abstract
Interest has increased in the potential role of circulating tumour cells in cancer management. Most cell‐based studies have been designed to determine the number of circulating tumour cells in a given volume of blood. Ability to understand the biology of the cancer cells would increase the clinical potential. The purpose of this study was to develop and validate a novel, widely applicable method for detection and characterisation of circulating tumour cells. Cells were imaged with an ImageStreamX imaging flow cytometer which allows detection of expression of multiple biomarkers on each cell and produces high‐resolution images. Depletion of haematopoietic cells was by red cell lysis, leukocyte common antigen CD45 depletion and differential centrifugation. Expression of epithelial cell adhesion molecule, cytokeratins, tumour‐type‐specific biomarkers and CD45 was detected by immunofluorescence. Nuclei were identified with DAPI or DRAQ5 and brightfield images of cells were collected. The method is notable for the dearth of cell damage, recoveries greater than 50%, speed and absence of reliance on the expression of a single biomarker by the tumour cells. The high‐quality images obtained ensure confidence in the specificity of the method. Validation of the methodology on samples from patients with oesophageal, hepatocellular, thyroid and ovarian cancers confirms its utility and specificity. Importantly, this adaptable method is applicable to all tumour types including those of nonepithelial origin. The ability to measure simultaneously the expression of multiple biomarkers will facilitate analysis of the cancer cell biology of individual circulating tumour cells. What's new? Circulating tumour cells (CTCs) are disseminated malignant cells from which biological and therapeutic information may be obtained non‐invasively. Detection of small CTC populations within the large number of normal blood cells is a challenge. This study describes a novel method for the detection and high‐resolution imaging of CTCs. Unlike most other studies, CTC detection is not reliant upon expression of a single biomarker. The method is applicable to all cancers; the authors present preliminary results from four tumour types. The high quality of the images allows biological characterisation of the tumour cells and increases the clinical potential of the approach.
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Affiliation(s)
- Barry M Dent
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne, United Kingdom
| | - Laura F Ogle
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rachel L O'Donnell
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Nicholas Hayes
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne, United Kingdom
| | - Ujjal Malik
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Nicola J Curtin
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alan V Boddy
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - E Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Richard J Edmondson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, The Liver Unit, Newcastle upon Tyne, United Kingdom
| | - Felicity E B May
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom
| | - David Jamieson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
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139
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Kallergi G, Agelaki S, Papadaki MA, Nasias D, Matikas A, Mavroudis D, Georgoulias V. Expression of truncated human epidermal growth factor receptor 2 on circulating tumor cells of breast cancer patients. Breast Cancer Res 2015; 17:113. [PMID: 26285572 PMCID: PMC4541732 DOI: 10.1186/s13058-015-0624-x] [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] [Received: 02/12/2015] [Accepted: 07/30/2015] [Indexed: 01/09/2023] Open
Abstract
Introduction The truncated form of human epidermal growth factor receptor 2 (p95HER2) lacks the HER2 extracellular domain and has been associated with poor prognosis and resistance to trastuzumab. In the present study, the expression of p95HER2 was investigated on circulating tumor cells (CTCs) from breast cancer patients. Methods Triple-staining immunofluorescent experiments were performed on peripheral blood mononuclear cells’ (PBMCs) cytospins obtained from patients with early (n = 24) and metastatic (n = 37) breast cancer. Cells were stained with the pancytokeratin (A45-B/B3) antibody coupled with antibodies against the extracellular (ECD) and the intracellular (ICD) domains of HER2. Slides were analyzed with either confocal laser scanning microscopy or with the Ariol system. Results HER2-positive CTCs were identified in 55.6 % of early and 65.2 % of metastatic CTC-positive breast cancer patients. p95HER2-positive CTCs were identified in 11.1 % of early and 39.1 % of metastatic breast cancer patients (p = 0.047). In 14 patients with metastatic HER2-positive breast cancer, CTCs were also analyzed before and after first-line trastuzumab therapy. Trastuzumab reduced the percentage of patients with full-length HER2-positive CTCs from 70 % at baseline to 50 % (p = 0.035) after treatment while increased the percentage of patients with p95HER2-positive CTCs from 40 % to 63 %. Moreover, the overall survival of metastatic patients with p95HER2-positive CTCs was significantly decreased (p = 0.03). Conclusions p95HER2-positive CTCs can be detected in both early and metastatic breast cancer patients. Their incidence is increased in the metastatic setting and their presence is associated with poor survival. Longitudinal studies during anti-HER2 treatment are required to determine the clinical relevance of p95HER2-expressing CTCs. Electronic supplementary material The online version of this article (doi:10.1186/s13058-015-0624-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Galatea Kallergi
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - Sofia Agelaki
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece. .,Department of Medical Oncology, University General Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece.
| | - Maria A Papadaki
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - Dimitris Nasias
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - Alexios Matikas
- Department of Medical Oncology, University General Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece.
| | - Dimitris Mavroudis
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece. .,Department of Medical Oncology, University General Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece.
| | - Vassilis Georgoulias
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
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140
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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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141
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The impact of HER2 phenotype of circulating tumor cells in metastatic breast cancer: a retrospective study in 107 patients. BMC Cancer 2015. [PMID: 25972110 DOI: 10.1186/s12885‐015‐1423‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In metastatic breast cancer (MBC), antigen profiles of metastatic tissue and primary tumor differ in up to 20 % of patients. Reassessment of predictive markers, including human epidermal growth factor receptor 2 (HER2) expression, might help to optimize MBC treatment. While tissue sampling is invasive and often difficult to repeat, circulating tumor cell (CTC) analysis requires only a blood sample and might provide an easy-to-repeat, real-time "liquid biopsy" approach. The present retrospective study was conducted to compare HER2 expression in primary tumors, metastatic tissue, and circulating tumor cells (CTCs) from MBC patients and to analyze the potential impact of HER2 overexpression by CTCs on progression-free (PFS) and overall survival (OS) in MBC. METHODS CTC-positive (five or more CTCs/7.5 mL blood; CellSearch®, Janssen Diagnostics) MBC patients starting a new line of systemic treatment were eligible for the study. HER2 status of CTCs was determined by immunofluorescence (CellSearch®). HER2 status of primary (PRIM) and metastatic (MET) tumor tissue was determined by immunohistochemistry. Data were analyzed using descriptive statistics and Kaplan-Meier plots. RESULTS One hundred seven patients (median age (range) 57 (33-81) years) were included. 100/107 (93%) patients were followed-up for a median [95% confidence interval (CI)] of 28.5 [25.1-40.1] months. Of 37/107 (35%) CTC-HER2-positive patients only 10 (27%) were PRIM-HER2-positive. 6/46 (13%) patients were MET-HER2-positive; only 2/10 (20%) CTC-HER2-positive patients were MET-HER2-positive. Overall accuracy between CTC-HER2 expression and PRIM-HER2 and MET-HER2 status was 69% and 74%, respectively. Kaplan-Meier plots of PFS and OS by CTC-HER2 status revealed significantly longer median [95% CI] PFS of CTC-HER2-positive versus CTC-HER2-negative patients (7.4 [4.7-13.7] versus 4.34 [3.5-5.9] months; p = 0.035). CTC-HER2-positive status showed no significant difference for OS (13.7 [7.7-30.0] versus 8.7 [5.9-15.3] months; p = 0.287). CONCLUSIONS HER2 status can change during the course of breast cancer. CTC phenotyping may serve as an easy-to-perform "liquid biopsy" to reevaluate HER2 status and potentially guide treatment decisions. Further, prospective studies are needed.
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Wallwiener M, Hartkopf AD, Riethdorf S, Nees J, Sprick MR, Schönfisch B, Taran FA, Heil J, Sohn C, Pantel K, Trumpp A, Schneeweiss A. The impact of HER2 phenotype of circulating tumor cells in metastatic breast cancer: a retrospective study in 107 patients. BMC Cancer 2015; 15:403. [PMID: 25972110 PMCID: PMC4435916 DOI: 10.1186/s12885-015-1423-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022] Open
Abstract
Background In metastatic breast cancer (MBC), antigen profiles of metastatic tissue and primary tumor differ in up to 20 % of patients. Reassessment of predictive markers, including human epidermal growth factor receptor 2 (HER2) expression, might help to optimize MBC treatment. While tissue sampling is invasive and often difficult to repeat, circulating tumor cell (CTC) analysis requires only a blood sample and might provide an easy-to-repeat, real-time “liquid biopsy” approach. The present retrospective study was conducted to compare HER2 expression in primary tumors, metastatic tissue, and circulating tumor cells (CTCs) from MBC patients and to analyze the potential impact of HER2 overexpression by CTCs on progression-free (PFS) and overall survival (OS) in MBC. Methods CTC-positive (five or more CTCs/7.5 mL blood; CellSearch®, Janssen Diagnostics) MBC patients starting a new line of systemic treatment were eligible for the study. HER2 status of CTCs was determined by immunofluorescence (CellSearch®). HER2 status of primary (PRIM) and metastatic (MET) tumor tissue was determined by immunohistochemistry. Data were analyzed using descriptive statistics and Kaplan–Meier plots. Results One hundred seven patients (median age (range) 57 (33–81) years) were included. 100/107 (93 %) patients were followed-up for a median [95 % confidence interval (CI)] of 28.5 [25.1–40.1] months. Of 37/107 (35 %) CTC-HER2-positive patients only 10 (27 %) were PRIM-HER2-positive. 6/46 (13 %) patients were MET-HER2-positive; only 2/10 (20 %) CTC-HER2-positive patients were MET-HER2-positive. Overall accuracy between CTC-HER2 expression and PRIM-HER2 and MET-HER2 status was 69 % and 74 %, respectively. Kaplan–Meier plots of PFS and OS by CTC-HER2 status revealed significantly longer median [95 % CI] PFS of CTC-HER2-positive versus CTC-HER2-negative patients (7.4 [4.7–13.7] versus 4.34 [3.5–5.9] months; p = 0.035). CTC-HER2-positive status showed no significant difference for OS (13.7 [7.7–30.0] versus 8.7 [5.9–15.3] months; p = 0.287). Conclusions HER2 status can change during the course of breast cancer. CTC phenotyping may serve as an easy-to-perform “liquid biopsy” to reevaluate HER2 status and potentially guide treatment decisions. Further, prospective studies are needed.
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Affiliation(s)
- Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Andreas Daniel Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
| | - Sabine Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Juliane Nees
- National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Martin Ronald Sprick
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Birgitt Schönfisch
- Department of Obstetrics and Gynecology, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Andreas Trumpp
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. .,National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
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Hall C, Karhade M, Laubacher B, Anderson A, Kuerer H, DeSynder S, Lucci A. Circulating Tumor Cells After Neoadjuvant Chemotherapy in Stage I-III Triple-Negative Breast Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S552-8. [PMID: 25968619 DOI: 10.1245/s10434-015-4600-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is characterized by a lack of estrogen and progesterone receptor expression and HER-2 gene amplification. Circulating tumor cells (CTCs) can be identified in 25 % of nonmetastatic breast cancer patients, and the identification of ≥1 CTC predicts outcome. This study was designed to determine whether CTCs present after neoadjuvant chemotherapy (NACT) predicted worse outcome in nonmetastatic TNBC patients. METHODS CTCs were assessed in 57 TNBC patients with nonmetastatic TNBC after the completion of NACT. CTCs (per 7.5 ml blood) were identified using the Cell Search(®) System (Janssen). Log-rank test and Cox regression analysis were applied to establish the association of CTCs with relapse-free (RFS) and overall survival (OS). RESULTS Median follow-up was 30 months, and mean age was 53 years. Fifty-four patients (95 %) had >2-cm tumors, 42 (84 %) were nuclear grade 3, and 42 (74 %) had positive axillary lymph nodes. One or more CTC was identified in 30 % of patients. CTC presence was not associated with primary tumor size, high grade, or lymph node positivity. Multivariate analysis demonstrated that detection of ≥1 CTC predicted decreased RFS (log-rank P = 0.03, HR 5.25, 95 % CI 1.34-20.56) and OS (log-rank P = 0.03, HR 7.04, 95 % CI 1.26-39.35). CONCLUSIONS One or more CTCs present after NACT predicted relapse and survival in nonmetastatic TNBC patients. This information would be helpful in future clinical trial design of adjuvant treatments for TNBC patients who are at risk for relapse after completing NACT.
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Affiliation(s)
- Carolyn Hall
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mandar Karhade
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Laubacher
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amber Anderson
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry Kuerer
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah DeSynder
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Frithiof H, Welinder C, Larsson AM, Rydén L, Aaltonen K. A novel method for downstream characterization of breast cancer circulating tumor cells following CellSearch isolation. J Transl Med 2015; 13:126. [PMID: 25896421 PMCID: PMC4409738 DOI: 10.1186/s12967-015-0493-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 01/05/2023] Open
Abstract
Background Enumeration of circulating tumor cells (CTCs) obtained from minimally invasive blood samples has been well established as a valuable monitoring tool in metastatic and early breast cancer, as well as in several other cancer types. The gold standard technology for detecting CTCs in blood against a backdrop of millions of leukocytes is the FDA-approved CellSearch system (Janssen Diagnostics), which relies on EpCAM-based immunomagnetic separation. Secondary characterization of these cells could enable treatment selection based on specific targets in these cells, as well as providing a real time window into the metastatic process and offering unique insights into tumor heterogeneity. The objective of this study was to develop a method for downstream characterization of CTCs following isolation with the CellSearch system. Methods An in vitro CTC model system focusing on clinically useful treatment predictive biomarkers in breast cancer, specifically the estrogen receptor α (ERα) and the human epidermal growth factor receptor 2 (HER2), was established using healthy donor blood spiked with breast cancer cell lines MCF7 (ERα+/HER2−) and SKBr3 (ERα−/HER2+). Following CTC isolation by CellSearch, the captured CTCs were further enriched and fixed on a microscope slide using the in-house-developed CTC-DropMount technique. Results The recovery rate of CTCs after CellSearch Profile analysis and CTC-DropMount was 87%. A selective and consistent triple-immunostaining protocol was optimized. Cells positive for DAPI, cytokeratin (CK) 8, 18 and 19, but negative for the leukocyte-specific marker CD45, were classified as CTCs and subsequently analyzed for ERα and HER2 expression. The method was verified in breast cancer patient samples, thus demonstrating its clinical relevance. Conclusions Our results show that it is possible to ascertain the status of important predictive biomarkers expressed in breast cancer CTCs using the newly developed CTC-DropMount technique. Downstream characterization of multiple biomarkers using a standard fluorescence microscope demonstrates that important clinical and biological information may be obtained from a single patient blood sample following either CellSearch epithelial or profile analyses. Trial registration Clinical Trials NCT01322893
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Affiliation(s)
- Henrik Frithiof
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Charlotte Welinder
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Anna-Maria Larsson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. .,Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden.
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden. .,Department of Surgery, Skåne University Hospital, Lund, Sweden.
| | - Kristina Aaltonen
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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Banys-Paluchowski M, Schneck H, Blassl C, Schultz S, Meier-Stiegen F, Niederacher D, Krawczyk N, Ruckhaeberle E, Fehm T, Neubauer H. Prognostic Relevance of Circulating Tumor Cells in Molecular Subtypes of Breast Cancer. Geburtshilfe Frauenheilkd 2015; 75:232-237. [PMID: 25914415 DOI: 10.1055/s-0035-1545788] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/31/2015] [Accepted: 03/03/2015] [Indexed: 12/15/2022] Open
Abstract
Circulating tumor cells (CTCs) can be detected in the peripheral blood of breast cancer patients with early and metastatic disease. Recent data suggest that immune pathologic characteristics between the primary tumor, metastatic colonies and CTCs are discordant and that CTCs possess an independent phenotype that is associated with prognosis and treatment efficacy. Large scale gene expression analysis has provided the possibility to stratify breast cancer according to the gene expression fingerprint of primary tumor tissue into five intrinsic molecular subtypes which can be associated with different clinical outcome. As a consequence of the different prognostic power of primary tumors' characteristics and CTCs several groups have started to investigate if CTCs might be disseminated differentially within these breast cancer subtypes. They determined the CTC number in immunohistochemical subtypes to validate if CTCs may provide differential and more specific prognostic information within each subtype. This review provides an overview of the outcome of some recently published data gathered from early and metastatic breast cancer.
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Affiliation(s)
- M Banys-Paluchowski
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf ; Department of Gynecology and Obstetrics, Marienkrankenhaus Hamburg, Hamburg
| | - H Schneck
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - C Blassl
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - S Schultz
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - F Meier-Stiegen
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - D Niederacher
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - N Krawczyk
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - E Ruckhaeberle
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - T Fehm
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
| | - H Neubauer
- Department of Gynecology and Obstetrics, Heinrich-Heine University Düsseldorf, Düsseldorf
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146
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Hart CD, Galardi F, De Luca F, Pestrin M, Di Leo A. Circulating Tumour Cells as Liquid Biopsy in Breast Cancer—Advancing from Prognostic to Predictive Potential. CURRENT BREAST CANCER REPORTS 2015. [DOI: 10.1007/s12609-014-0177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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147
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McInnes LM, Jacobson N, Redfern A, Dowling A, Thompson EW, Saunders CM. Clinical implications of circulating tumor cells of breast cancer patients: role of epithelial-mesenchymal plasticity. Front Oncol 2015; 5:42. [PMID: 25767772 PMCID: PMC4341429 DOI: 10.3389/fonc.2015.00042] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/05/2015] [Indexed: 12/19/2022] Open
Abstract
There is increasing interest in circulating tumor cells (CTCs) due to their purported role in breast cancer metastasis, and their potential as a “liquid biopsy” tool in breast cancer diagnosis and management. There are, however, questions with regards to the reliability and consistency of CTC detection and to the relationship between CTCs and prognosis, which is limiting their clinical utility. There is increasing acceptance that the ability of CTCs to alter from an epithelial to mesenchymal phenotype plays an important role in determining the metastatic potential of these cells. This review examines the phenotypic and genetic variation, which has been reported within CTC populations. Importantly, we discuss how the detection and characterization of CTCs provides additional and often differing information from that obtained from the primary tumor, and how this may be utilized in determining prognosis and treatment options. It has been shown for example that hormone receptor status often differs between the primary tumor and CTCs, which may help to explain failure of endocrine treatment. We examine how CTC status may introduce alternative treatment options and also how they may be used to monitor treatment. Finally, we discuss the most interesting current clinical trials involving CTC analysis and note further research that is required before the breast cancer “liquid biopsy” can be realized.
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Affiliation(s)
- Linda M McInnes
- School of Surgery, The University of Western Australia , Perth, WA , Australia
| | - Natalie Jacobson
- School of Surgery, The University of Western Australia , Perth, WA , Australia
| | - Andrew Redfern
- Medical Oncology, Royal Perth Hospital , Perth, WA , Australia
| | - Anthony Dowling
- Department of Medical Oncology, St Vincent's Hospital Melbourne , Melbourne, VIC , Australia
| | - Erik W Thompson
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology , Brisbane, QLD , Australia ; St. Vincent's Institute , Melbourne, VIC , Australia ; Department of Surgery, St Vincent's Hospital, University of Melbourne , Melbourne, VIC , Australia
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148
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Wang HY, Ahn S, Kim S, Park S, Jung D, Park S, Han H, Sohn J, Kim S, Lee H. Detection of circulating tumor cell-specific markers in breast cancer patients using the quantitative RT-PCR assay. Int J Clin Oncol 2015; 20:878-90. [PMID: 25708591 DOI: 10.1007/s10147-015-0798-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/29/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Breast cancer is a highly prevalent disease among women worldwide. While the expression of certain proteins within breast cancer tumors is used to determine the prognosis and select therapies, additional markers need to be identified. Circulating tumor cells (CTCs) are constituent cells that have detached from a primary tumor to circulate in the bloodstream. CTCs are considered the main source of breast cancer metastases; therefore, detection of CTCs could be a promising diagnostic method for metastatic breast cancer. METHODS In this study, the CircleGen CTC RT-qDx assay was used to analyze the mRNA expression levels of six CTC-specific markers including EpCAM, CK19, HER2, Ki67, hTERT, and vimentin with a total of 692 peripheral whole blood samples from 221 breast cancer patients and 376 healthy individuals. RESULTS This assay showed high specificity with multiple markers; none of the healthy controls were detected positive, whereas 21.7 and 14 % of breast cancer patients were positive for EpCAM and CK19, respectively. Of the 221 breast cancer patients, 84 (38 %), 46 (20.8 %), 83 (37.6 %), and 39 (17.6 %) were positively for HER2, Ki67, hTERT, and vimentin mRNA, respectively. Of the 84 patients who were HER2 positive, nine (4 %) were also positive for EpCAM, CK19, Ki67, hTERT, and vimentin. Of the 139 breast cancer patients who were HER2 negative, 65 (29.1 %) were negative for EpCAM, CK19, Ki67, hTERT, and vimentin. Furthermore, the EpCAM-positive population decreased from 21.5 to 8.3 % after completion of anti-tumor treatment (TP4). Similarly, the CK19, HER2, hTERT, and vimentin positives also decreased from 13.9 to 9.5 %, from 37.7 to 21.4 %, from 37.2 to 33.3 %, and from 17.5 to 14.3 %, respectively, after completion of anti-tumor treatment. In contrast, the Ki67 positives increased from 20.6 to 41.7 % after completion of anti-tumor treatment. CONCLUSIONS mRNA overexpression of six CTC-specific markers was detected by the CircleGen CTC RT-qDx assay with high specificity, and the obtained mRNA expression levels of CTC-specific markers might provide useful criteria to select appropriate anti-tumor treatment for breast cancer patients.
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Affiliation(s)
- Hye-Young Wang
- M&D, Inc., Wonju Eco Environmental Technology Center, Wonju, Gangwon, Republic of Korea
| | - Sungwoo Ahn
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon, 220-710, Republic of Korea
| | - Sunghyun Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon, 220-710, Republic of Korea
- Institute for Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Sunyoung Park
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon, 220-710, Republic of Korea
| | - Dongju Jung
- Department of Biomedical Laboratory Science, College of Natural Sciences, Hoseo University, Chungnam, Republic of Korea
| | - Sangjung Park
- Department of Clinical Laboratory Science, College of Medical Science, Daegu Haany University, Daegu, Republic of Korea
| | - Hyunju Han
- Avison Biomedical Research Center, Yonsei University Medical Center, Seoul, Republic of Korea
| | - JooHyuk Sohn
- Division of Medical Oncology, Severance Breast Cancer Clinic, Yonsei Cancer Center, Seoul, Republic of Korea
| | - SeungIl Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon, 220-710, Republic of Korea.
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Hartkopf AD, Wallwiener M, Hahn M, Fehm TN, Brucker SY, Taran FA. Simultaneous Detection of Disseminated and Circulating Tumor Cells in Primary Breast Cancer Patients. Cancer Res Treat 2015; 48:115-24. [PMID: 25687853 PMCID: PMC4720101 DOI: 10.4143/crt.2014.287] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/09/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose Disseminated tumor cells (DTCs) from bone marrow (BM) are a surrogate of minimal residual disease (MRD) in primary breast cancer (PBC) patients and associated with an adverse prognosis. However, BM sampling is an invasive procedure. Although there is growing evidence that circulating tumor cells (CTCs) from the blood are also suitable for monitoring MRD, data on the simultaneous detection of DTCs and CTCs are limited. Materials and Methods We determined the presence of DTCs using immunocytochemistry and the pan-cytokeratin antibody A45-B/B3. CTCs were determined simultaneously using a reverse transcription-polymerase chain reaction–based assay (AdnaTest Breast Cancer) and CellSearch (at least one CTC per 7.5 mL blood). We compared the detection of DTCs and CTCs and evaluated their impact on disease-free and overall survival. Results Of 585 patients, 131 (22%) were positive for DTCs; 19 of 202 (9%) and 18 of 383 (5%) patients were positive for CTCs, as shown by AdnaTest and CellSearch, respectively. No significant association was observed between DTCs and CTCs (p=0.248 and p=0.146 as shown by AdnaTest and CellSearch, respectively). The presence of DTCs (p=0.046) and the presence of CTCs as shown by CellSearch (p=0.007) were predictive of disease-free survival. Conclusion Our data confirm the prognostic relevance of DTCs and CTCs in patients with PBC. As we found no significant relationship between DTCs and CTCs, prospective trials should include their simultaneous detection. Within those trials, the question of whether or not DTCs and CTCs are independent subpopulations of malignant cell clones should be determined by molecular characterization.
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Affiliation(s)
- Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Markus Hahn
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Tanja N Fehm
- Department of Obstetrics and Gynecology, University of Duesseldorf, Duesseldorf, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
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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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