CTCs in primary breast cancer (II)

Comparing blood versus tissue-based biomarkers expression in breast cancer patients

Molecular markers have been used as a tool for diagnostic approaches, staging, and evaluation of therapeutic responses in patients with cancer. Cancer molecular markers can also help clinicians to make decision on therapy and prognosis evaluation at the time of diagnosis. In the early diagnosis of breast cancer (BC), estrogen and progesterone receptors (ER/PR) expression levels should be determined through immunohistochemistry (IHC). In molecular genetics, there are some important tissue-based markers that can also be found in blood, such as Mammaglobin (MAM), Cytokeratin 19 (CK19), Mucin (MUC), Proto-oncogene (c-Myc), antigen Ki-67 (Ki67), and Carcinoembryonic antigen (CEA). In this study, the positive level of the marker genes in both blood and tissue of the BC patients were compared using reverse transcription polymerase chain reaction (RT-PCR) method. In addition, the importance of blood vs. tissue-based markers in BC diagnosis also demonstrated and is discussed. CEA (O), ERβ, CK19 and, c-Myc molecular markers were significantly different between blood of normal and patients while there was no significant difference of these markers in tissue samples. Blood-based biomarkers can be used for the early diagnosis of BC. Comparing blood versus tissue-based biomarkers indicated that there are correlations between markers in blood and tissue, since blood markers can be substitute to tissue markers in BC patients in the future.

The Clinical Utility of Circulating Tumor Cells in Breast Cancer Patients: Detection by a Quantitative Assay of h-MAM Gene Expression

The aim of this study was to evaluate tumor markers of molecular abnormalities that display tissue specificity, as to detect circulating tumor cells (CTCs) in breast cancer patients. Quantitative real-time RT-PCR was used to determine h-MAM, BCSG1, CK19, and c-erbB2 mRNA levels in peripheral blood (PB) of breast cancer patients. Results were compared with other epithelial cancers (lung or esophagus cancer), benign breast disease, and healthy individuals. We found that h-MAM mRNA was only detectable in the PB of patients with breast cancer (49 of 65, 75.4%), but not in patients with other epithelial cancers, benign breast disease, or healthy individuals. No significant differences in the expression level and positive detection rate of BCSG1, CK19, and c-erbB2 mRNA were observed between breast cancer and other epithelial cancers. Furthermore, the expression level and positive detection rate of h-MAM mRNA in PB were significantly correlated to the breast cancer pathologic stage (p=0.012 and p=0.015, respectively). Chemotherapy, radiotherapy, or total tumor resection (after 7 days of treatment) resulted in a significant decrease in the expression level of h-MAM mRNA in PB compared to the levels prior to the treatment (p<0.001). Importantly, an increase in h-MAM mRNA expression was detected in patients immediately after surgery, as well as 3 days post-surgery. These results indicate that the quantitative analysis of h-MAM mRNA is a useful tool for detecting CTCs in breast cancer patients, and can have a potential diagnostic utility in early micrometastasis, clinical evaluation of cancer treatment efficacy, and post-treatment monitoring of breast cancer patients.

Detection of Circulating Tumour Cells from Blood of Breast Cancer Patients via RT-qPCR

Breast cancer is still the most frequent cause of cancer-related death in women worldwide. Often death is not caused only by the primary tumour itself, but also by metastatic lesions. Today it is largely accepted, that these remote metastases arise out of cells, which detach from the primary tumour, enter circulation, settle down at secondary sites in the body and are called Circulating Tumour Cells (CTCs). The occurrence of such minimal residual diseases in the blood of breast cancer patients is mostly linked to a worse prognosis for therapy outcome and overall survival. Due to their very low frequency, the detection of CTCs is, still a technical challenge. RT-qPCR as a highly sensitive method could be an approach for CTC-detection from peripheral blood of breast cancer patients. This assumption is based on the fact that CTCs are of epithelial origin and therefore express a different gene panel than surrounding blood cells. For the technical approach it is necessary to identify appropriate marker genes and to correlate their gene expression levels to the number of tumour cells within a sample in an in vitro approach. After that, samples from adjuvant and metastatic patients can be analysed. This approach may lead to new concepts in diagnosis and treatment.