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Pailler E, Auger N, Lindsay CR, Vielh P, Islas-Morris-Hernandez A, Borget I, Ngo-Camus M, Planchard D, Soria JC, Besse B, Farace F. High level of chromosomal instability in circulating tumor cells of ROS1-rearranged non-small-cell lung cancer. Ann Oncol 2015; 26:1408-15. [PMID: 25846554 PMCID: PMC4478971 DOI: 10.1093/annonc/mdv165] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/16/2015] [Indexed: 12/02/2022] Open
Abstract
ROS1-rearrangement can be detected in circulating tumor cells of ROS1-rearranged non-small-cell lung cancer patients, offering perspectives for diagnosing patients eligible for ROS1-inhibitor therapy. ROS1-rearranged CTCs show considerable heterogeneity of ROS1-gene abnormalities and elevated numerical chromosomal instability, a potential mechanism of resistance to ROS1-inhibitor. Background Genetic aberrations affecting the c-ros oncogene 1 (ROS1) tyrosine kinase gene have been reported in a small subset of patients with non-small-cell lung cancer (NSCLC). We evaluated whether ROS1-chromosomal rearrangements could be detected in circulating tumor cells (CTCs) and examined tumor heterogeneity of CTCs and tumor biopsies in ROS1-rearranged NSCLC patients. Patients and methods Using isolation by size of epithelial tumor cells (ISET) filtration and filter-adapted-fluorescence in situ hybridization (FA-FISH), ROS1 rearrangement was examined in CTCs from four ROS1-rearranged patients treated with the ROS1-inhibitor, crizotinib, and four ROS1-negative patients. ROS1-gene alterations observed in CTCs at baseline from ROS1-rearranged patients were compared with those present in tumor biopsies and in CTCs during crizotinib treatment. Numerical chromosomal instability (CIN) of CTCs was assessed by DNA content quantification and chromosome enumeration. Results ROS1 rearrangement was detected in the CTCs of all four patients with ROS1 rearrangement previously confirmed by tumor biopsy. In ROS1-rearranged patients, median number of ROS1-rearranged CTCs at baseline was 34.5 per 3 ml blood (range, 24–55). In ROS1-negative patients, median background hybridization of ROS1-rearranged CTCs was 7.5 per 3 ml blood (range, 7–11). Tumor heterogeneity, assessed by ROS1 copy number, was significantly higher in baseline CTCs compared with paired tumor biopsies in the three patients experiencing PR or SD (P < 0.0001). Copy number in ROS1-rearranged CTCs increased significantly in two patients who progressed during crizotinib treatment (P < 0.02). CTCs from ROS1-rearranged patients had a high DNA content and gain of chromosomes, indicating high levels of aneuploidy and numerical CIN. Conclusion We provide the first proof-of-concept that CTCs can be used for noninvasive and sensitive detection of ROS1 rearrangement in NSCLC patients. CTCs from ROS1-rearranged patients show considerable heterogeneity of ROS1-gene abnormalities and elevated numerical CIN, a potential mechanism to escape ROS1-inhibitor therapy in ROS1-rearranged NSCLC tumors.
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Affiliation(s)
- E Pailler
- INSERM U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", University of Paris-Sud XI, Gustave Roussy, Villejuif Translational Research Laboratory, Gustave Roussy, Villejuif
| | - N Auger
- Departments of Biopathology, Gustave Roussy, Villejuif, France
| | - C R Lindsay
- INSERM U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", University of Paris-Sud XI, Gustave Roussy, Villejuif Translational Research Laboratory, Gustave Roussy, Villejuif
| | - P Vielh
- INSERM U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", University of Paris-Sud XI, Gustave Roussy, Villejuif Translational Research Laboratory, Gustave Roussy, Villejuif Departments of Biopathology, Gustave Roussy, Villejuif, France
| | | | - I Borget
- Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | | | | | - J-C Soria
- INSERM U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", University of Paris-Sud XI, Gustave Roussy, Villejuif Medicine, Gustave Roussy, Villejuif, France
| | - B Besse
- Medicine, Gustave Roussy, Villejuif, France
| | - F Farace
- INSERM U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", University of Paris-Sud XI, Gustave Roussy, Villejuif Translational Research Laboratory, Gustave Roussy, Villejuif
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102
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Circulating tumor cells in lung cancer: detection methods and clinical applications. Lung 2015; 193:157-71. [PMID: 25690734 DOI: 10.1007/s00408-015-9697-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 02/09/2015] [Indexed: 12/26/2022]
Abstract
Circulating tumor cells (CTCs) are tumor cells that have disseminated from primary and metastatic sites, and circulate in the bloodstream. Advanced immunological and molecular-based methods can be used to detect and analyze the cells with the characteristics of tumor cells, and can be detected and analyzed in the blood of cancer patients. The most commonly used methods in lung cancer combine the processes of immunomagnetic enrichment and immunocytochemical detection, morphology-based enrichment coupled with reverse transcriptase polymerase chain reaction (RT-PCR), and RT-PCR alone. CTC analysis is considered a liquid biopsy approach for early diagnosis, risk stratification, evaluation of curative efficacy, and early detection of lung cancer relapse. In this review, we discuss the present techniques for analyzing CTCs, and the restrictions of using these methods in lung cancer. We also review the clinical studies in lung cancer and discuss the underlying associations between these studies and their future applications to this disease.
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103
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Detection of EGFR mutations in the plasma of patients with lung adenocarcinoma for real-time monitoring of therapeutic response to tyrosine kinase inhibitors? J Thorac Oncol 2015; 9:e49-e50. [PMID: 24926553 PMCID: PMC4132039 DOI: 10.1097/jto.0000000000000134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Future options for ALK-positive non-small cell lung cancer. Lung Cancer 2015; 87:211-9. [PMID: 25601484 DOI: 10.1016/j.lungcan.2014.12.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/21/2014] [Accepted: 12/24/2014] [Indexed: 01/10/2023]
Abstract
Recent advances in the understanding of non-small cell lung cancer (NSCLC) biology have revealed a number of 'targetable' genetic alterations that underlie cancer growth and survival in specific patients subgroups. The anaplastic lymphoma kinase (ALK) gene rearrangement identifies a population of NSCLCs in whom dysregulation of ALK-tyrosine kinase (-TK) leads to uncontrolled proliferation of cancer cells, thus providing the basis for the therapeutic use of ALK-TK inhibitors (-TKIs) in ALK-rearranged (-positive) disease. Crizotinib was the first ALK-TKI to undergo clinical development in ALK-positive advanced NSCLC, in which it has been shown to greatly outperform the best available chemotherapy regimen in either second- or first-line setting. More recently, the novel second-generation ALK-TKI ceritinib has been shown to be highly active in either crizotinib-pretreated or -naïve population. Nevertheless, as mechanisms of resistance to crizotinib and ALK-TKIs in general are being progressively elucidated, the treatment landscape of ALK-positive NSCLC is expected to evolve rapidly. In the present review we will briefly discuss the current knowledge of ALK-positive advanced non-small cell lung cancer. Also, we will touch upon new developments on drugs/combination regimens aimed at inhibiting the ALK-TK, in an attempt to delineate how treatment of ALK-positive disease may change in the next future.
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105
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Circulating Tumor Cells: Who is the Killer? CANCER MICROENVIRONMENT 2014; 7:161-76. [PMID: 25527469 PMCID: PMC4275541 DOI: 10.1007/s12307-014-0164-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/27/2014] [Indexed: 01/05/2023]
Abstract
This article is a critical note on the subject of Circulating Tumor Cells (CTC). It takes into account the tumor identity of Circulating Tumor Cells as cancer seeds in transit from primary to secondary soils, rather than as a “biomarker”, and considers the help this field could bring to cancer patients. It is not meant to duplicate information already available in a large number of reviews, but to stimulate considerations, further studies and development helping the clinical use of tumor cells isolated from blood as a modern personalized, non-invasive, predictive test to improve cancer patients’ life. The analysis of CTC challenges, methodological bias and critical issues points out to the need of referring to tumor cells extracted from blood without any bias and identified by cytopathological diagnosis as Circulating Cancer Cells (CCC). Finally, this article highlights recent developments and identifies burning questions which should be addressed to improve our understanding of the domain of CCC and their potential to change the clinical practice.
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106
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Ilie M, Hofman V, Long E, Bordone O, Selva E, Washetine K, Marquette CH, Hofman P. Current challenges for detection of circulating tumor cells and cell-free circulating nucleic acids, and their characterization in non-small cell lung carcinoma patients. What is the best blood substrate for personalized medicine? ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:107. [PMID: 25489581 DOI: 10.3978/j.issn.2305-5839.2014.08.11] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/13/2014] [Indexed: 12/29/2022]
Abstract
The practice of "liquid biopsy" as a diagnostic, prognostic and theranostic tool in non-small cell lung cancer (NSCLC) patients is an appealing approach, at least in theory, since it is noninvasive and easily repeated. In particular, this approach allows patient monitoring during treatment, as well as the detection of different genomic alterations that are potentially accessible to targeted therapy or are associated with treatment resistance. However, clinical routine practice is slow to adopt the liquid biopsy. Several reasons may explain this: (I) the vast number of methods described for potential detection of circulating biomarkers, without a consensus on the ideal technical approach; (II) the multiplicity of potential biomarkers for evaluation, in particular, circulating tumor cells (CTCs) vs. circulating tumor DNA (ctDNA); (III) the difficulty in controlling the pre-analytical phase to obtain robust and reproducible results; (IV) the present cost of the currently available techniques, which limits accessibility to patients; (V) the turnaround time required to obtain results that are incompatible with the urgent need for delivery of treatment. The purpose of this review is to describe the main advances in the field of CTC and ctDNA detection in NSCLC patients and to compare the main advantages and disadvantages of these two approaches.
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Affiliation(s)
- Marius Ilie
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Véronique Hofman
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Elodie Long
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Olivier Bordone
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Eric Selva
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Kevin Washetine
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Charles Hugo Marquette
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Paul Hofman
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
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107
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Faugeroux V, Pailler E, Auger N, Taylor M, Farace F. Clinical Utility of Circulating Tumor Cells in ALK-Positive Non-Small-Cell Lung Cancer. Front Oncol 2014; 4:281. [PMID: 25414829 PMCID: PMC4220657 DOI: 10.3389/fonc.2014.00281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/29/2014] [Indexed: 12/17/2022] Open
Abstract
The advent of rationally targeted therapies such as small-molecule tyrosine kinase inhibitors (TKIs) has considerably transformed the therapeutic management of a subset of patients with non-small-cell lung cancer (NSCLC) harboring defined molecular abnormalities. When such genetic molecular alterations are detected the use of specific TKI has demonstrated better results (overall response rate, progression free survival) compared to systemic therapy. However, the detection of such molecular abnormalities is complicated by the difficulty in obtaining sufficient tumor material, in terms of quantity and quality, from a biopsy. Here, we described how circulating tumor cells (CTCs) can have a clinical utility in anaplastic lymphoma kinase (ALK) positive NSCLC patients to diagnose ALK-EML4 gene rearrangement and to guide therapeutic management of these patients. The ability to detect genetic abnormalities such ALK rearrangement in CTCs shows that these cells could offer new perspectives both for the diagnosis and the monitoring of ALK-positive patients eligible for treatment with ALK inhibitors.
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Affiliation(s)
- Vincent Faugeroux
- INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment," Institut Gustave Roussy, University of Paris-Sud , Paris , France ; Translational Research Laboratory, Institut Gustave Roussy , Paris , France
| | - Emma Pailler
- INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment," Institut Gustave Roussy, University of Paris-Sud , Paris , France ; Translational Research Laboratory, Institut Gustave Roussy , Paris , France
| | - Nathalie Auger
- Department of Biopathology, Institut Gustave Roussy , Paris , France
| | - Melissa Taylor
- INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment," Institut Gustave Roussy, University of Paris-Sud , Paris , France ; Translational Research Laboratory, Institut Gustave Roussy , Paris , France
| | - Françoise Farace
- INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment," Institut Gustave Roussy, University of Paris-Sud , Paris , France ; Translational Research Laboratory, Institut Gustave Roussy , Paris , France
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108
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Immunohistochimie et médecine personnalisée en oncologie pulmonaire: potentialités et limites. Bull Cancer 2014; 101:958-65. [DOI: 10.1684/bdc.2014.2041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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109
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Tognela A, Spring KJ, Becker T, Caixeiro NJ, Bray VJ, Yip PY, Chua W, Lim SH, de Souza P. Predictive and prognostic value of circulating tumor cell detection in lung cancer: a clinician's perspective. Crit Rev Oncol Hematol 2014; 93:90-102. [PMID: 25459665 DOI: 10.1016/j.critrevonc.2014.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 07/13/2014] [Accepted: 10/01/2014] [Indexed: 12/14/2022] Open
Abstract
There is increasing evidence for the use of circulating tumor cells (CTCs) as a "liquid biopsy" for early detection of lung cancer recurrence, prognosticating disease and monitoring treatment response. Further, CTC molecular analysis and interrogation of single cells hold significant potential in providing insights into tumor biology and the metastatic process. Ongoing research will likely see the translation of CTCs as a prognostic and predictive biomarker in both small cell, and non-small cell, lung cancer to routine clinical practice.
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Affiliation(s)
- Annette Tognela
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; Macarthur Clinical School, University of Western Sydney, Campbelltown 2560, Australia; Department of Medical Oncology, Campbelltown Hospital, Campbelltown 2560, Australia.
| | - Kevin J Spring
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia
| | - Therese Becker
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia
| | - Nicole J Caixeiro
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - Victoria J Bray
- Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia
| | - Po Yee Yip
- Department of Medical Oncology, Campbelltown Hospital, Campbelltown 2560, Australia; Sydney Medical School, University of Sydney, Camperdown 2006, Australia
| | - Wei Chua
- Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia
| | - Stephanie H Lim
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia
| | - Paul de Souza
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool 2170, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool 2170, Australia; South West Sydney Translational Cancer Research Unit, Liverpool 2170, Australia; School of Medicine, University of New South Wales, Kensington 2052, Australia; Macarthur Clinical School, University of Western Sydney, Campbelltown 2560, Australia
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110
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Clinical utility of circulating tumour cell detection in non-small-cell lung cancer. Curr Treat Options Oncol 2014; 14:610-22. [PMID: 23996475 DOI: 10.1007/s11864-013-0253-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Recent years have witnessed increased interest in the detection of circulating tumour cells (CTCs) for diagnosis, monitoring, and treatment decision making in patients with cancer. Factors that have led to accelerated research in this field include advances in technologies for examination of intact CTCs, personalised medicine with treatment selection according to molecular characteristics, and continued lack of understanding of the biology of treatment resistance and metastasis. CTCs offer promise as a surrogate for tissue where there is insufficient tissue for molecular analysis and where there is a requirement to serially monitor molecular changes in cancer cells through treatment or on progression. In patients with either small cell or non-small cell lung cancer (NSCLC), there is evidence that CTC number is prognostic and that CTCs counted before and after treatment mirror treatment response. In patients with molecularly defined subtypes of NSCLC, CTCs demonstrate the same molecular changes as the cancer cells of the tumour. However, CTCs are not quite ready for "primetime" in the lung cancer clinic. There are still more questions than answers with respect to the optimal technologies for their detection and analysis, their biological significance, and their clinical utility. Despite this the current pace of progress in CTC technology development seems set to make "liquid biopsies" a clinical reality within the next decade. For the everyday clinician and clinical trialist, it will be important to maintain knowledge of the strengths and weaknesses of the technologies and evolving evidence base for CTCs as a routinely used diagnostic tool.
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111
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Clinicopathological and demographical characteristics of non-small cell lung cancer patients with ALK rearrangements: a systematic review and meta-analysis. PLoS One 2014; 9:e100866. [PMID: 24959902 PMCID: PMC4069179 DOI: 10.1371/journal.pone.0100866] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/30/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This meta-analysis aimed to comprehensively examine the relationship between the clinicopathological and demographical characteristics and ALK rearrangements in patients with non-small cell lung cancer (NSCLC). METHODS AND MAIN FINDINGS In total, 62 qualified articles including 1178 ALK rearranged cases from 20541 NSCLC patients were analyzed, and the data were extracted independently by two investigators. NSCLC patients with ALK rearrangements tended to be younger than those without (mean difference: -7.16 years; 95% confidence interval (95% CI): -9.35 to -4.96; P<0.00001), even across subgroups by race. Compared with female NSCLC patients, the odds ratio (OR) of carrying ALK rearrangements was reduced by 28% (95% CI: 0.58-0.90; P = 0.004) in males, and this reduction was potentiated in Asians, yet in opposite direction in Caucasians. Likewise, smokers were less likely to have ALK rearrangements than never-smokers (OR = 0.33; 95% CI: 0.25-0.44; P<0.00001), even in race-stratified subgroups. Moreover, compared with NSCLC patients with tumor stage IV, ALK rearrangements were underrepresented in those with tumor stage I-III (OR = 0.58; 95% CI: 0.44-0.78; P = 0.0002). Patients with lung adenocarcinomas had a significantly higher rate of ALK rearrangements (7.2%) than patients with non-adenocarcinoma (2.0%) (OR = 2.25; 95% CI: 1.54-3.27; P<0.0001). CONCLUSION Our findings demonstrate that ALK rearrangements tended to be present in NSCLC patients with no smoking habit, younger age and tumor stage IV. Moreover, race, age, gender, smoking status, tumor stage and histology might be potential sources of heterogeneity.
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112
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Lowes LE, Allan AL. Recent advances in the molecular characterization of circulating tumor cells. Cancers (Basel) 2014; 6:595-624. [PMID: 24633084 PMCID: PMC3980613 DOI: 10.3390/cancers6010595] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/28/2014] [Accepted: 02/20/2014] [Indexed: 12/16/2022] Open
Abstract
Although circulating tumor cells (CTCs) were first observed over a century ago, lack of sensitive methodology precluded detailed study of these cells until recently. However, technological advances have now facilitated the identification, enumeration, and characterization of CTCs using a variety of methods. The majority of evidence supporting the use of CTCs in clinical decision-making has been related to enumeration using the CellSearch® system and correlation with prognosis. Growing evidence also suggests that CTC monitoring can provide an early indication of patient treatment response based on comparison of CTC levels before and after therapy. However, perhaps the greatest potential that CTCs hold for oncology lies at the level of molecular characterization. Clinical treatment decisions may be more effective if they are based on molecular characteristics of metastatic cells rather than on those of the primary tumor alone. Molecular characterization of CTCs (which can be repeatedly isolated in a minimally invasive fashion) provides the opportunity for a "real-time liquid biopsy" that allows assessment of genetic drift, investigation of molecular disease evolution, and identification of actionable genomic characteristics. This review focuses on recent advances in this area, including approaches involving immunophenotyping, fluorescence in situ hybridization (FISH), multiplex RT-PCR, microarray, and genomic sequencing.
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Affiliation(s)
- Lori E Lowes
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 4L6, Canada.
| | - Alison L Allan
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 4L6, Canada.
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113
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Krebs MG, Metcalf RL, Carter L, Brady G, Blackhall FH, Dive C. Molecular analysis of circulating tumour cells-biology and biomarkers. Nat Rev Clin Oncol 2014; 11:129-44. [PMID: 24445517 DOI: 10.1038/nrclinonc.2013.253] [Citation(s) in RCA: 452] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Growing evidence for intratumour heterogeneity informs us that single-site biopsies fall short of revealing the complete genomic landscape of a tumour. With an expanding repertoire of targeted agents entering the clinic, screening tumours for genomic aberrations is increasingly important, as is interrogating the tumours for resistance mechanisms upon disease progression. Multiple biopsies separated spatially and temporally are impractical, uncomfortable for the patient and not without risk. Here, we describe how circulating tumour cells (CTCs), captured from a minimally invasive blood test-and readily amenable to serial sampling-have the potential to inform intratumour heterogeneity and tumour evolution, although it remains to be determined how useful this will be in the clinic. Technologies for detecting and isolating CTCs include the validated CellSearch(®) system, but other technologies are gaining prominence. We also discuss how recent CTC discoveries map to mechanisms of haematological spread, previously described in preclinical models, including evidence for epithelial-mesenchymal transition, collective cell migration and cells with tumour-initiating capacity within the circulation. Advances in single-cell molecular analysis are enhancing our ability to explore mechanisms of metastasis, and the combination of CTC and cell-free DNA assays are anticipated to provide invaluable blood-borne biomarkers for real-time patient monitoring and treatment stratification.
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Affiliation(s)
- Matthew G Krebs
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester and Manchester Cancer Research Centre, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Robert L Metcalf
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester and Manchester Cancer Research Centre, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Louise Carter
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester and Manchester Cancer Research Centre, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Ged Brady
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester and Manchester Cancer Research Centre, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Fiona H Blackhall
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester and Manchester Cancer Research Centre, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester and Manchester Cancer Research Centre, 550 Wilmslow Road, Manchester M20 4BX, UK
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114
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King JD, Casavant BP, Lang JM. Rapid translation of circulating tumor cell biomarkers into clinical practice: technology development, clinical needs and regulatory requirements. LAB ON A CHIP 2014; 14:24-31. [PMID: 24190548 DOI: 10.1039/c3lc50741f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The great hope in circulating tumor cell (CTC) research lies in the use of these rare cells as an accessible "fluid biopsy" that would permit frequent, minimally invasive sampling of tumor cells for similar molecular assays that are performed on traditional biopsies. Given the rarity of CTCs in peripheral circulation, microscale methods show great promise and superiority to capture and analyze these cells from patients with solid tumors. Novel technologies that produce validated CTC biomarkers may finally provide medical oncologists the tools needed to provide precise, personalized medical care for patients with advanced cancer. However, few CTC technologies demonstrate both experimental and clinical evidence of an accurate, reliable and reproducible assay that also meets the regulatory requirements to enter routine clinical practice. Many opportunities exist to incorporate clinical needs and regulatory benchmarks into technology development to more quickly garner FDA approval to direct decisions on patient care. This review will address: 1) device development tailored to address predictive, prognostic and/or therapeutic needs across the multitude of malignancies and disease stages; 2) validation benchmarks for clinical assay development; 3) early establishment of standard operating procedures for sample acquisition and analysis; 4) demonstration of clinical utility; 5) clinical qualification of a novel biomarker; and 6) integration of a newly validated and qualified technology into routine clinical practice. Early understanding and incorporation of these regulatory requirements into assay development can simplify and speed the integration of these novel technologies into patient care. Meeting these benchmarks will lead to the true personalization of cancer therapies, directing initial and subsequent treatments for each individual based on initial tumor characteristics while monitoring for emerging mechanisms of resistance in these continually evolving tumors.
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Affiliation(s)
- Jonathan D King
- Department of Medicine, Wisconsin Institutes for Medical Research, University of Wisconsin, 1111 Highland Ave., Madison, WI 53705, USA.
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Carter L, Metcalf R, Blackhall FH, Dive C, Krebs MG. Biology and clinical relevance of circulating tumour cells. J Thorac Dis 2013; 4:453-5. [PMID: 23050105 DOI: 10.3978/j.issn.2072-1439.2012.09.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/07/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Louise Carter
- Clinical and Experimental Pharmacology Group, Paterson institute for Cancer Research, Manchester, UK
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Costa DB. Identification of Somatic Genomic Alterations in Circulating Tumors Cells: Another Step Forward in Non–Small-Cell Lung Cancer? J Clin Oncol 2013; 31:2236-9. [DOI: 10.1200/jco.2013.48.9229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Daniel B. Costa
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Affiliation(s)
- Maria P Wong
- Department of Pathology, The University of Hong Kong, Hong Kong
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Usefulness of immunocytochemistry for the detection of the BRAF(V600E) mutation in circulating tumor cells from metastatic melanoma patients. J Invest Dermatol 2013; 133:1378-81. [PMID: 23303445 DOI: 10.1038/jid.2012.485] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Thunnissen E, Bubendorf L, Dietel M, Elmberger G, Kerr K, Lopez-Rios F, Moch H, Olszewski W, Pauwels P, Penault-Llorca F, Rossi G. EML4-ALK testing in non-small cell carcinomas of the lung: a review with recommendations. Virchows Arch 2012; 461:245-57. [PMID: 22825000 PMCID: PMC3432214 DOI: 10.1007/s00428-012-1281-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/21/2012] [Accepted: 07/02/2012] [Indexed: 11/25/2022]
Abstract
In non-small cell lung cancer, epidermal growth factor receptor gene mutations and anaplastic lymphoma kinase (ALK) gene rearrangements have a major impact upon the level of response to treatment with specific tyrosine kinase inhibitors. This review describes the molecular basis of ALK inhibition, summarizes current data on the effectiveness and safety of ALK inhibition therapy, describes the different testing methodologies with their advantages and disadvantages, provides a suggested testing algorithm and puts forward a proposal for an external quality assessment program in ALK testing.
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Affiliation(s)
- Erik Thunnissen
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
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