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Payer P, Röder M, Camara O, Pachmann K. High depletion of breast cancer cells from the peripheral blood with the method of non-specific separation. Ecancermedicalscience 2020; 14:1003. [PMID: 32104205 PMCID: PMC7039695 DOI: 10.3332/ecancer.2020.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 11/06/2022] Open
Abstract
Circulating epithelial tumour cells (CETCs) play an important role in the formation of metastases in breast cancer patients. The depletion of such CETCs from peripheral blood of breast cancer patients using non-specific separation (without antibodies) of tumour cells from normal blood leucocytes might contribute to reduce the load of the patient’s blood with tumour cells and subsequently reduce the probability of metastasis formation. This method is based on cell type-specific interaction of living cells with Carboxymethyl Dextrane (CMD) coated magnetic nanoparticles. We have developed a mild flow separation method using CMD-coated magnetic nanoparticles (core size ca. 25 nm) along with a low-field gradient magnetic separator and an external separation column (blood bag). The ability of tumour cells to preferentially bind such particles and to separate tumour cells from the white blood cells from blood samples of 25 breast cancer patients (fresh and 24-hour stored blood samples) were tested. The circulating tumour cells were quantified before and after separation by maintrac analysis. We achieved a very high depletion rate of tumour cells to < 3% remaining in the investigated 24 hours stored blood samples and ≤14% in all fresh blood samples concurrent with maintaining 56% ± 4% of vital leukocytes in all fresh blood samples.
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Affiliation(s)
- Petra Payer
- INNOVENT e. V., Prüssingstraße 27 B, D-07745 Jena, Germany
| | - Michael Röder
- INNOVENT e. V., Prüssingstraße 27 B, D-07745 Jena, Germany
| | - Oumar Camara
- Hufeland Klinikum GmbH, Rudolph-Weiss-Straße 1-5, D-99947 Bad Langensalza, Germany
| | - Katharina Pachmann
- Transfusionsmedizinisches Zentrum Bayreuth, Kurpromenade 2, D-95448 Bayreuth, Germany
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Pachmann K, Schuster S. The Value of Monitoring the Behavior of Circulating Tumor Cells at the End of Endocrine Therapy in Breast Cancer Patients. Cancers (Basel) 2018; 10:cancers10110407. [PMID: 30380648 PMCID: PMC6266844 DOI: 10.3390/cancers10110407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023] Open
Abstract
After five years of endocrine therapy, patients with ER+ (estrogen receptor positive) breast cancer face the question of the benefit of further treatment. Ten years of endocrine therapy has been demonstrated to improve survival compared to five years. However, the individual benefit of continuation remains unclear. Therefore, markers for predicting benefit from endocrine treatment and extended endocrine treatment are desperately needed. In this study the dynamics over time of the tumor cells circulating in peripheral blood of patients, circulating tumor cells/ circulating epithelial tumor cells (CTC/CETC), as the systemic part of the tumor were investigated in 36 patients with ER+ primary breast cancer. CTC/CETCs were monitored serially during and after endocrine therapy. After termination of endocrine therapy 12 patients showed an increase in CTC/CETCs, with 8 of 12 suffering relapse. No change or a reduction was observed in 24 patients, with 2 of 24 suffering relapse. Initial tumor size was marginally prognostic (p = 0.053) but not nodal status nor the mere number of CTC/CETCs. Only the trajectory of CTC/CETCs was a statistically significant predictor of relapse free survival (increasing cell numbers: mean = 940 days vs. stable/decreasing cell numbers mean not reached). Individual cases demonstrated that an increase of CTC/CETCs after discontinuation of tamoxifen therapy could be stopped by resuming the endocrine therapy.
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Affiliation(s)
- Katharina Pachmann
- Medizinisches Labor Pachmann, SIMFO GmbH, Kurpromenade 2, 95448 Bayreuth, Germany.
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3
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Suh YS, Joung JY, Kim SH, Seo HK, Chung J, Lee KH. Establishment and Application of Prostate Cancer Circulating Tumor Cells in the Era of Precision Medicine. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7206307. [PMID: 29230413 PMCID: PMC5694577 DOI: 10.1155/2017/7206307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/27/2017] [Indexed: 11/17/2022]
Abstract
Prostate cancer (PC) is the second most common cancer in men and is the fifth leading cause of cancer-related deaths worldwide. Additionally, there is concern for overdiagnosis and overtreatment of PC. Thus, selection of an appropriate candidate for active surveillance as well as more accurate and less invasive tools for monitoring advanced PC is required. Circulating tumor cells (CTCs) have emerged as a liquid biopsy tool; there have been several reports on its role, technologies, and applications to various cancers, including PC. Liquid biopsy using CTCs has been gaining attention as a minimal invasive tool for investigation of biomarkers and for prognosis and assessment of response to therapies in patients with PC. Because of the lower invasiveness of liquid biopsy using CTCs, it can be performed more frequently; accordingly, personalized disease status can be successively determined at serial time points. CTC analysis enables detection of genomic alterations, which is drug-targetable, and it is a potential tool for monitoring response to therapeutic agents in patients with PC. This review focuses on the characteristics, technologies for analysis, and advantages and disadvantages of CTCs as a liquid biopsy tool and their application in PC. Finally, we propose future directions of CTCs.
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Affiliation(s)
- Yoon Seok Suh
- Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Jae Young Joung
- Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Sung Han Kim
- Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Ho Kyung Seo
- Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Jinsoo Chung
- Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Kang Hyun Lee
- Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
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Schott DS, Pizon M, Pachmann U, Pachmann K. Sensitive detection of PD-L1 expression on circulating epithelial tumor cells (CETCs) could be a potential biomarker to select patients for treatment with PD-1/PD-L1 inhibitors in early and metastatic solid tumors. Oncotarget 2017; 8:72755-72772. [PMID: 29069824 PMCID: PMC5641167 DOI: 10.18632/oncotarget.20346] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/11/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The current cancer research strongly focuses on immune therapies, where the PD-1, with its ligands plays an important role. It is known that PD-L1 is frequently up-regulated in a number of different cancers and the relevance of this pathway has been extensively studied and therapeutic approaches targeting PD-1 and PD-L1 have been developed. We used a non-invasive, real-time biopsy for determining PD-L1 and PD-L2 expression in CETCs of solid cancer patients. METHODS CETCs were determined from blood of 128 patients suffering from breast (72), prostate (27), colorectal (18) and lung (11) cancer. The number of vital CETCs and the expression of PD-L1 and PD-L2 were investigated using the maintrac® method. RESULTS PD-L1 expressing CETCs were detected in 94.5% of breast, 100% of prostate, 95.4% of colorectal and 82% of lung cancer patients whereas only 75% of breast cancer patients had PD-L2 positive CETCs. In the PD-L1 and PD-L2 expressing patients the cell fraction of PD-L1 positive CETCs is significantly higher than the fraction of PD-L2 positive CETCs (54.6% vs. 28.7%; p<0.001). Breast cancer patients with metastatic disease had significantly more PD-L1 positive CETCs as compared to patients without metastasis (median 75% vs. 61.1%; p<0.05). CONCLUSION PD-L1 seems to be a major factor in immune evasion and is highly expressed on CETCs regardless of the type of cancer. Monitoring the frequency of PD-L1 positive CETCs could reflect individual patient's response for an anti-PD-1/PD-L1 therapy and may be a promising target of anticancer treatment.
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5
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Dendrimer-assisted hydrophilic magnetic nanoparticles as sensitive substrates for rapid recognition and enhanced isolation of target tumor cells. Talanta 2016; 161:925-931. [DOI: 10.1016/j.talanta.2016.08.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/15/2016] [Accepted: 08/21/2016] [Indexed: 01/12/2023]
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Leong SM, Tan KML, Chua HW, Tan D, Fareda D, Osmany S, Li MH, Tucker S, Koay ESC. Sampling circulating tumor cells for clinical benefits: how frequent? J Hematol Oncol 2015; 8:75. [PMID: 26108208 PMCID: PMC4488127 DOI: 10.1186/s13045-015-0174-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/15/2015] [Indexed: 11/21/2022] Open
Abstract
Circulating tumor cells (CTCs) are cells shed from tumors or metastatic sites and are a potential biomarker for cancer diagnosis, management, and prognostication. The majority of current studies use single or infrequent CTC sampling points. This strategy assumes that changes in CTC number, as well as phenotypic and molecular characteristics, are gradual with time. In reality, little is known today about the actual kinetics of CTC dissemination and phenotypic and molecular changes in the blood of cancer patients. Herein, we show, using clinical case studies and hypothetical simulation models, how sub-optimal CTC sampling may result in misleading observations with clinical consequences, by missing out on significant CTC spikes that occur in between sampling times. Initial studies using highly frequent CTC sampling are necessary to understand the dynamics of CTC dissemination and phenotypic and molecular changes in the blood of cancer patients. Such an improved understanding will enable an optimal, study-specific sampling frequency to be assigned to individual research studies and clinical trials and better inform practical clinical decisions on cancer management strategies for patient benefits.
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Affiliation(s)
- Sai Mun Leong
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Karen M L Tan
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Hui Wen Chua
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Doreen Tan
- Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore
| | - Delly Fareda
- Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore
| | - Saabry Osmany
- Radlink PET and Cardiac Imaging Center, 290 Orchard Road, #08-06 Paragon Medical, Singapore, 238859, Singapore
| | - Mo-Huang Li
- CellSievo Private Limited Singapore, Block 289A, Bukit Batok St. 25, #15-218, Singapore, 650289, Singapore
| | - Steven Tucker
- Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore
| | - Evelyn S C Koay
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Pathology, National University of Singapore, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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Pachmann K. Current and potential use of MAINTRAC method for cancer diagnosis and prediction of metastasis. Expert Rev Mol Diagn 2015; 15:597-605. [PMID: 25843106 DOI: 10.1586/14737159.2015.1032260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cells shed from solid malignant tumors into the circulation are considered to be the origin of metastases. In spite of a wealth of research on the pathway of metastasis formation, it is still not clear when and how metastases develop, nor is there a consensus on the number and the nature of circulating tumor cells present in individual patients and their relationship to the formation of metastases. We have developed a method to detect a maximum of unselected non-hematological, epithelial cells in the blood, assuming that in cancer patients the majority of these cells are derived from the tumor. Assessment of the number of these cells longitudinally during the course of disease and therapy allows the response to different treatments to be monitored. Due to the viability of the cells, additional analyses such as expression profiles and determination of their sensitivity to drugs can be performed.
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Paczesny S, Duncan C, Jacobsohn D, Krance R, Leung K, Carpenter P, Bollard C, Renbarger J, Cooke K. Opportunities and challenges of proteomics in pediatric patients: circulating biomarkers after hematopoietic stem cell transplantation as a successful example. Proteomics Clin Appl 2014; 8:837-50. [PMID: 25196024 DOI: 10.1002/prca.201400033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/30/2014] [Accepted: 09/03/2014] [Indexed: 11/06/2022]
Abstract
Biomarkers have the potential to improve diagnosis and prognosis, facilitate-targeted treatment, and reduce health care costs. Thus, there is great hope that biomarkers will be integrated in all clinical decisions in the near future. A decade ago, the biomarker field was launched with great enthusiasm because MS revealed that blood contains a rich library of candidate biomarkers. However, biomarker research has not yet delivered on its promise due to several limitations: (i) improper sample handling and tracking as well as limited sample availability in the pediatric population, (ii) omission of appropriate controls in original study designs, (iii) lability and low abundance of interesting biomarkers in blood, and (iv) the inability to mechanistically tie biomarker presence to disease biology. These limitations as well as successful strategies to overcome them are discussed in this review. Several advances in biomarker discovery and validation have been made in hematopoietic stem cell transplantation, the current most effective tumor immunotherapy, and these could serve as examples for other conditions. This review provides fresh optimism that biomarkers clinically relevant in pediatrics are closer to being realized based on: (i) a uniform protocol for low-volume blood collection and preservation, (ii) inclusion of well-controlled independent cohorts, (iii) novel technologies and instrumentation with low analytical sensitivity, and (iv) integrated animal models for exploring potential biomarkers and targeted therapies.
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Affiliation(s)
- Sophie Paczesny
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Blom A, Bhatia S, Pietromonaco S, Koehler K, Iyer JG, Nagase K, Paulson K, Sabath DE, Nghiem P. Clinical utility of a circulating tumor cell assay in Merkel cell carcinoma. J Am Acad Dermatol 2013; 70:449-55. [PMID: 24388423 DOI: 10.1016/j.jaad.2013.10.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 10/07/2013] [Accepted: 10/28/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Quantitation of circulating tumor cells (CTCs) has utility in managing breast, colon, and prostate carcinomas. OBJECTIVE We sought to determine whether a commercially available CTC assay provides prognostic information in Merkel cell carcinoma (MCC), insight into treatment responses, or both. METHODS We analyzed CTCs in 52 specimens from 34 patients with MCC. RESULTS The presence of CTCs correlated with extent of disease at blood draw (P = .004). Among 15 patients with regional nodal disease, CTC-negative patients had 80% disease-specific survival at 2 years after the test, versus 29% for CTC-positive patients (P = .015). Among the entire cohort, those without CTCs had 72% MCC-specific survival whereas CTC-positive patients had 25% survival (n = 34, median follow-up 19 months, P = .0003). Fifty seven percent of patients with MCC had a cytokeratin "dot" visible in 20% or more of CTCs, a feature that was absent among CTCs from other carcinomas (0 of 13 cases). LIMITATIONS CTC assay was performed at variable times after diagnosis and heterogeneity in extent of disease affects interpretability of the data. CONCLUSION CTC detection in MCC is feasible and appears to add prognostic information, particularly in patients with regional nodal disease. It may also assist clinical management in certain situations, including differentiating metastatic MCC cells from those of other carcinomas.
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Affiliation(s)
- Astrid Blom
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Shailender Bhatia
- Department of Medicine/Oncology, University of Washington, Seattle, Washington
| | | | - Karen Koehler
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jayasri G Iyer
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Kotaro Nagase
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Kelly Paulson
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington
| | - Daniel E Sabath
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Paul Nghiem
- Department of Medicine/Dermatology, University of Washington, Seattle, Washington.
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Rudiger N, Stein EL, Schill E, Spitz G, Rabenstein C, Stauch M, Rengsberger M, Runnebaum IB, Pachmann U, Pachmann K. Chemosensitivity Testing of Circulating Epithelial Tumor Cells (CETC) in <i>Vitro</i>: Correlation to in <i>Vivo</i> Sensitivity and Clinical Outcome. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jct.2013.42077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Heterogeneity of ERα and ErbB2 Status in Cell Lines and Circulating Tumor Cells of Metastatic Breast Cancer Patients. Transl Oncol 2012; 5:475-85. [PMID: 23323159 DOI: 10.1593/tlo.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 09/06/2012] [Accepted: 10/30/2012] [Indexed: 02/07/2023] Open
Abstract
Hormone therapy and anti-ErbB2 therapies are prescribed according to the hormone receptor [estrogen receptor α (ERα)/progesterone receptor] and ErbB2 status of the initial tumor, but it appears that circulating tumor cells (CTCs) and, consequently, the metastatic cells may have a different receptor status. As an attempt to meet the crucial need for identification of the subpopulation of patients that will benefit from more individualized therapies, rapidly evolving therapies should allow a profiling of the tumors and/or of the CTCs. We established a triple fluorescence staining using eight cell lines to visualize the CTCs (cytokeratin detection) and then to define their individual ERα and ErbB2 status. Afterward, we used this method for blood samples from 26 metastatic breast cancer patients. We identified major differences of ERα levels between the cell lines and even within one cell line. For the metastatic patients, we detected and characterized CTCs in 38.5% of the patients with a total of 92 CTCs. We could demonstrate that at least 69.6% of the CTCs exhibit an ERα and/or ErbB2 status different from the status of the primary tumor and that the CTCs from only 30% of the patients had no change of receptor status. Strikingly, heterogeneities of the status, aggregation, and size clearly appear within the CTCs. The data we generated outline the importance of a profiling not only of tumors but also of CTCs to establish individualized treatments. CTCs may then appear as new prognosis and treatment marker for both metastatic and adjuvant breast cancers.
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Aurilio G, Sciandivasci A, Munzone E, Sandri MT, Zorzino L, Cassatella MC, Verri E, Rocca MC, Nolè F. Prognostic value of circulating tumor cells in primary and metastatic breast cancer. Expert Rev Anticancer Ther 2012; 12:203-14. [PMID: 22316368 DOI: 10.1586/era.11.208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with breast cancer, there is evidence correlating the presence of circulating tumor cells (CTCs) with disease-free survival, progression-free survival and overall survival. The detection of CTCs may be useful in gaining a better understanding of the mechanisms of tumor growth and in the improvement of patient management. This review analyzes the prognostic and predictive relevance of CTCs through the principal published studies, cytometric techniques and nucleic acid-based approaches to detect CTCs, phenotypic expression of specific receptors, molecular pathways and genetic signatures for potential tailored therapies.
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Affiliation(s)
- Gaetano Aurilio
- European Institute of Oncology, Medical Care Unit, Department of Medical Oncology, Ripamonti Street 435, Milan 20141, Italy.
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SERRANO MARÍAJOSÉ, ROVIRA PEDROSÁNCHEZ, MARTÍNEZ-ZUBIAURRE I, RODRIGUEZ MIGUELDELGADO, FERNÁNDEZ MÓNICA, LORENTE JOSEA. Dynamics of circulating tumor cells in early breast cancer under neoadjuvant therapy. Exp Ther Med 2012; 4:43-48. [PMID: 23060920 PMCID: PMC3460281 DOI: 10.3892/etm.2012.540] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/20/2012] [Indexed: 12/25/2022] Open
Abstract
At present, the majority of patients with breast cancer are diagnosed at early stages of disease development. However, a considerable number of such cases develop secondary malignancies after a relatively short period of time. The presence of circulating tumor cells (CTCs) has been proposed as a strong biomarker to predict disease recurrence in metastatic breast cancer. However, the prognostic significance is not clear in early breast cancer. We present results on CTC determination in peripheral blood in non-metastatic breast cancer patients in the context of neoadjuvant treatment. Twenty-six breast cancer patients, scheduled for neoadjuvant therapy, were enrolled in a prospective study, of which 24 were able to complete therapy. CTC assessment was performed by sorting out cytokeratin-positive cells from 10 ml of peripheral blood using immunomagnetic separation, followed by immunocytochemical characterization of cells. Seventeen blood samples out of 24 patients were CTC-positive when collected prior to neoadjuvant chemotherapy. No significant correlations were found between the presence of CTCs and lymph node status (p=0.1), histological type (p=0.802), stage (p=0.43) or overall survival (OS) (p=0.599). Thirteen CTC-positive samples were observed in blood samples collected after treatment. Univariate analyses revealed that the presence of CTCs was related to OS when the detection was positive both before and after treatment (p=0.023). CTCs can be a strong prognostic marker in early breast cancer. The persistence of CTCs before and after treatment can identify a subpopulation of patients with an increased risk of recurrence.
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Affiliation(s)
- MARÍA JOSÉ SERRANO
- Centro Pfizer, Universidad de Granada, Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), Granada
| | | | | | | | | | - JOSE A. LORENTE
- Centro Pfizer, Universidad de Granada, Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), Granada
- Laboratory of Genetic Identification – UGR, Department of Legal Medicine, University of Granada, Granada,
Spain
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Katharina P. Tumor cell seeding during surgery-possible contribution to metastasis formations. Cancers (Basel) 2011; 3:2540-53. [PMID: 24212822 PMCID: PMC3757431 DOI: 10.3390/cancers3022540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 01/11/2023] Open
Abstract
In spite of optimal local control in breast cancer, distant metastases can develop as a systemic part of this disease. Surgery is suspected to contribute to metastasis formation activating dormant tumor cells. Here we add data that seeding of cells during surgery may add to the risk of metastasis formation. The change in circulating epithelial tumor cells (CETC) was monitored in 66 breast cancer patients operated on with breast conserving surgery or mastectomy and during the further course of the disease, analyzing CETC from unseparated white blood cells stained with FITC-anti-EpCAM. An increase in cell numbers lasting until the start of chemotherapy was observed in about one third of patients. It was more preeminent in patients with low numbers of CETC before surgery and, surprisingly, in patients without involved lymph nodes. Patients with the previously reported behavior—Reincrease in cell numbers during adjuvant chemotherapy and subsequent further increase during maintenance therapy—were at increased risk of relapse. In addition to tumor cells already released during growth of the tumor, cell seeding during surgery may contribute to the early peak of relapses observed after removal of the primary tumor and chemotherapy may only marginally postpone relapse in patients with aggressively growing tumors.
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Affiliation(s)
- Pachmann Katharina
- Department of Experimental Hematology and Oncology, Clinic for Internal Medicine II, Friedrich Schiller University, Jena D-07747, Germany.
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15
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Detection of EpCAM-Negative and Cytokeratin-Negative Circulating Tumor Cells in Peripheral Blood. JOURNAL OF ONCOLOGY 2011; 2011:252361. [PMID: 21577258 PMCID: PMC3090615 DOI: 10.1155/2011/252361] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/14/2011] [Indexed: 12/17/2022]
Abstract
Enrichment of rare circulating tumor cells (CTCs) in blood is typically achieved using antibodies to epithelial cell adhesion molecule (EpCAM), with detection using cytokeratin (CK) antibodies. However, EpCAM and CK are not expressed in some tumors and can be downregulated during epithelial-to-mesenchymal transition. A micro-fluidic system, not limited to EpCAM or CK, was developed to use multiple antibodies for capture followed by detection using CEE-Enhanced (CE), a novel in situ staining method that fluorescently labels the capture antibodies bound to CTCs. Higher recovery of CTCs was demonstrated using antibody mixtures compared to anti-EpCAM. In addition, CK-positive breast cancer cells were found in 15 of 24 samples (63%; range 1–60 CTCs), while all samples contained additional CE-positive cells (range 1–41; median = 11; P = .02). Thus, antibody mixtures against a range of cell surface antigens enables capture of more CTCs than anti-EpCAM alone and CE staining enables the detection of CK-negative CTCs.
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Graves H, Czerniecki BJ. Circulating tumor cells in breast cancer patients: an evolving role in patient prognosis and disease progression. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:621090. [PMID: 21253472 PMCID: PMC3022182 DOI: 10.4061/2011/621090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 12/09/2010] [Indexed: 12/30/2022]
Abstract
In this paper, we examine the role of circulating tumor cells (CTCs) in breast cancer. CTCs are tumor cells present in the peripheral blood. They are found in many different carcinomas but are not present in patients with benign disease. Recent advances in theories regarding metastasis support the role of early release of tumor cells in the neoplastic process. Furthermore, it has been found that phenotypic variation exists between the primary tumor and CTCs. Of particular interest is the incongruency found between primary tumor and CTC HER2 status in both metastatic and early breast cancer. Overall, CTCs have been shown to be a poor prognostic marker in metastatic breast cancer. CTCs in early breast cancer are not as well studied, however, several studies suggest that the presence of CTCs in early breast cancer may also suggest a poorer prognosis. Studies are currently underway looking at the use of CTC level monitoring in order to guide changes in therapy.
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Affiliation(s)
- Holly Graves
- Harrison Department of Surgical Research, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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