1
|
Ring A, Nguyen-Sträuli BD, Wicki A, Aceto N. Biology, vulnerabilities and clinical applications of circulating tumour cells. Nat Rev Cancer 2023; 23:95-111. [PMID: 36494603 PMCID: PMC9734934 DOI: 10.1038/s41568-022-00536-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Abstract
In recent years, exceptional technological advances have enabled the identification and interrogation of rare circulating tumour cells (CTCs) from blood samples of patients, leading to new fields of research and fostering the promise for paradigm-changing, liquid biopsy-based clinical applications. Analysis of CTCs has revealed distinct biological phenotypes, including the presence of CTC clusters and the interaction between CTCs and immune or stromal cells, impacting metastasis formation and providing new insights into cancer vulnerabilities. Here we review the progress made in understanding biological features of CTCs and provide insight into exploiting these developments to design future clinical tools for improving the diagnosis and treatment of cancer.
Collapse
Affiliation(s)
- Alexander Ring
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bich Doan Nguyen-Sträuli
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
- Department of Gynecology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Nicola Aceto
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland.
| |
Collapse
|
2
|
Mou Y, Song Y, Liu J, Song H, Liu X, Li J, Ke N. Long Term Outcomes of No-Touch Isolation Principles Applied in Pancreaticoduodenectomy for Treatment of Pancreatic Adenocarcinoma: A Multicenter Retrospective Study with Propensity Score Matching. J Clin Med 2023; 12:jcm12020632. [PMID: 36675561 PMCID: PMC9866505 DOI: 10.3390/jcm12020632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Background: The recurrence and liver metastasis rates are still high in pancreatic head cancer with curative surgical resection. A no-touch isolation principle in pancreaticoduodenectomy (PD) may improve this situation, however, the exact advantages and efficacy of these principles have not been confirmed. Materials and methods: Among 370 patients who underwent PD, three centers were selected and classified into two groups: the no-touch PD group (n = 70) and the conventional PD group (n = 300). Propensity score matching was used to control for selection bias at a ratio of 1:1. The confounding variables were age, sex, body mass index, adjuvant chemotherapy, carbohydrate antigen 19-9, tumor size and tumor differentiation. Results: Patients in the no-touch PD group had better overall survival (OS) and disease-free survival (DFS) than those in the conventional PD group (OS: 17 vs. 13 months, p = 0.0035, DFS: 15 vs. 12 months, p = 0.087), with lower 1- and 2-year disease-related mortality rates (1-year: 32.9% vs. 47%, p = 0.032; 2-year: 42.5% vs. 82% p = 0.000) and recurrence and liver metastasis rates (1-year: 30.0% vs. 43.3%, p = 0.041; 2-year: 34.3% vs. 48.7%, p = 0.030). Compared with the matched conventional PD group, the no-touch PD group also had a better OS (17 vs. 12 months, p = 0.032). Conclusions: Our study showed the no-touch isolation principle may be a better choice to improve long-term survival for pancreatic cancer patients.
Collapse
Affiliation(s)
- Yu Mou
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi Song
- Early Phase Clinical Research Unit, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jinheng Liu
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu 610011, China
| | - Haiyu Song
- Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu 610011, China
| | - Xubao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiang Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Correspondence: (J.L.); (N.K.)
| | - Nengwen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (J.L.); (N.K.)
| |
Collapse
|
3
|
Abdelgawad IA. Epithelial Cell Adhesion Molecule mRNA Can be a Potential Marker to Predict Metastasis in Hepatocellular Carcinoma Patients. Asian Pac J Cancer Prev 2020; 21:861-866. [PMID: 32212818 PMCID: PMC7437321 DOI: 10.31557/apjcp.2020.21.3.861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Epithelial cell adhesion molecule [EpCAM] is a surface marker of cancer stem cells that can maintain the capacity for malignant proliferation, invasion, metastasis, and tumor recurrence; hence its detection among hepatocellular carcinoma [HCC] patients may be an important prognostic factor. The aim of this study was to detect EpCAM mRNA expression in the whole blood of HCC patients and normal control subjects to elucidate its clinico-pathological significance among patients with HCC. METHODS This study was conducted on 74 newly diagnosed HCC patients and forty normal control subjects. Both groups were subjected to the detection of EpCAM mRNA in the whole blood using reverse transcriptase polymerase chain reaction [RT- PCR] technique. EpCAM expression was compared with some of the established prognostic factors of HCC. RESULTS EpCAM was detected in 17.5% of the HCC cases and was not expressed in any of the normal control subjects. EpCAM positive cases showed higher serum levels of alpha- feto protein [AFP] and carcinoembryonic antigen [CEA]. Prevalence of EpCAM positivity gave significant results with distant metastasis, lymph node metastasis, and portal vein thrombosis. CONCLUSION EpCAM proved high specificity among HCC patients and its expression was associated with metastasis and portal vein thrombosis. Higher serum levels of CEA among the EpCAM positive patients may attract the attention to a subgroup of HCC patients who are more liable to develop metastasis.<br />.
Collapse
Affiliation(s)
- Iman A Abdelgawad
- Department of Clinical Pathology, NCI, Cairo University, Cairo, Egypt
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Although liquid biopsies hold significant promise in the management of patients with cancer, peripheral blood analyses remain dependent on the degree of tumor burden with prohibitively low yields until the cancer is widely metastatic. Multiple lines of evidence support a dynamic, spatiotemporal localization of circulating tumor cells (CTCs) supporting specific targeting of vascular compartments, such as the portal vein. This review discusses the literature evaluating the possibility of portal venous blood as a new, potentially higher yield liquid biopsy and the current devices and techniques for endoscopic ultrasound (EUS)-guided portal venous sampling for CTC detection. RECENT FINDINGS Two recent studies in pancreatic cancer have demonstrated that portal venous blood can be safely sampled via EUS and consistently yields significantly higher CTC counts compared with matched peripheral blood. EUS-acquired samples can be used for molecular testing, clinical prognostication, and drug sensitivity analyses. Portal venous CTCs are identified in higher quantity relative to peripheral blood and can be safely obtained via EUS. Further studies are required to demonstrate the clinical utility of EUS-guided portal venous tumor material enrichment and analysis; however, obtaining EUS-guided "liquid biopsies" appears to merit significant consideration for procedural adoption.
Collapse
Affiliation(s)
- Christopher G Chapman
- Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine and Biological Sciences, 5700 S Maryland Ave. MC 8043, Chicago, IL, 60637, USA
| | - Irving Waxman
- Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine and Biological Sciences, 5700 S Maryland Ave. MC 8043, Chicago, IL, 60637, USA.
| |
Collapse
|
5
|
Dai X, Zhang X, Lu P. Toward a holistic view of multiscale breast cancer molecular biomarkers. Biomark Med 2019; 13:1509-1533. [PMID: 31668082 DOI: 10.2217/bmm-2019-0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Powered by rapid technology developments, biomarkers become increasingly diverse, including those detected at genomic, transcriptomic, proteomic, metabolomic and cellular levels. While diverse sets of biomarkers have been utilized in breast cancer predisposition, diagnosis, prognosis, treatment and management, recent additions derived from lincRNA, circular RNA, circulating DNA together with its methylated and hydroxymethylated forms and immune signatures are likely to further transform clinical practice. Here, we take breast cancer as an example of heterogeneous diseases that require many informed decisions from treatment to care to review the huge variety of biomarkers. By assessing the advantages and limitations of modern biomarkers in diverse use scenarios, this article outlines the prospects and challenges of releasing complimentary advantages by augmentation of multiscale molecular biomarkers.
Collapse
Affiliation(s)
- Xiaofeng Dai
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, PR China
| | - Xuanhao Zhang
- School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, PR China
| | - Peihua Lu
- Wuxi People's Hospital, Nan Chang Qu, Wuxi, Jiangsu, PR China
| |
Collapse
|
6
|
|
7
|
Sai B, Xiang J. Disseminated tumour cells in bone marrow are the source of cancer relapse after therapy. J Cell Mol Med 2018; 22:5776-5786. [PMID: 30255991 PMCID: PMC6237612 DOI: 10.1111/jcmm.13867] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/11/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023] Open
Abstract
Accumulating evidence indicates that cancer cells spread much earlier than was previously believed. Recent technological advances have greatly improved the detection methods of circulating tumour cells (CTCs), suggesting that the dissemination of cancer cells into the circulation occurs randomly. Most CTCs die in circulation as a result of shear stress and/or anoikis. However, the persistence of disseminated tumour cells (DTCs) in the bone marrow is the result of interaction of DTCs with bone marrow microenvironment. DTCs in the bone marrow undergo successive clonal expansions and a parallel progression that leads to new variants. Compared to the CTCs, DTCs in the bone marrow have a unique signature, which displayed dormant, mesenchymal phenotype and osteoblast-like or osteoclast-like phenotype. The persistence of DTCs in the bone marrow is always related to minimal residual diseases (MRDs). This review outlines the difference between CTCs and DTCs in the bone marrow and describes how this difference affects the clinical values of CTCs and DTCs, such as metastasis and recurrence. We suggest that DTCs remaining in the bone marrow after therapy can be used as a superior marker in comparison with CTCs to define patients with an unfavourable prognosis and may therefore be a potential prognostic factor and therapeutic target for cancer therapy.
Collapse
Affiliation(s)
- Buqing Sai
- Hunan Cancer HospitalThe Affiliated Cancer Hospital of Xiangya School of MedicineCentral South UniversityChangshaHunanChina
- Cancer Research InstituteSchool of Basic Medical ScienceCentral South UniversityChangshaHunanChina
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of HealthXiangya HospitalCentral South UniversityChangshaHunanChina
| | - Juanjuan Xiang
- Hunan Cancer HospitalThe Affiliated Cancer Hospital of Xiangya School of MedicineCentral South UniversityChangshaHunanChina
- Cancer Research InstituteSchool of Basic Medical ScienceCentral South UniversityChangshaHunanChina
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of HealthXiangya HospitalCentral South UniversityChangshaHunanChina
- Hunan Key Laboratory of Nonresolving Inflammation and CancerChangshaHunanChina
| |
Collapse
|
8
|
Hagemann J, Jacobi C, Gstoettner S, Welz C, Schwenk-Zieger S, Stauber R, Strieth S, Kuenzel J, Baumeister P, Becker S. Therapy Testing in a Spheroid-based 3D Cell Culture Model for Head and Neck Squamous Cell Carcinoma. J Vis Exp 2018. [PMID: 29733308 DOI: 10.3791/57012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Current treatment options for advanced and recurrent head and neck squamous cell carcinoma (HNSCC) enclose radiation and chemo-radiation approaches with or without surgery. While platinum-based chemotherapy regimens currently represent the gold standard in terms of efficacy and are given in the vast majority of cases, new chemotherapy regimens, namely immunotherapy are emerging. However, the response rates and therapy resistance mechanisms for either chemo regimen are hard to predict and remain insufficiently understood. Broad variations of chemo and radiation resistance mechanisms are known to date. This study describes the development of a standardized, high-throughput in vitro assay to assess HNSCC cell line's response to various therapy regimens, and hopefully on primary cells from individual patients as a future tool for personalized tumor therapy. The assay is designed to being integrated into the quality-controlled standard algorithm for HNSCC patients at our tertiary care center; however, this will be subject of future studies. Technical feasibility looks promising for primary cells from tumor biopsies from actual patients. Specimens are then transferred into the laboratory. Biopsies are mechanically separated followed by enzymatic digestion. Cells are then cultured in ultra-low adhesion cell culture vials that promote the reproducible, standardized and spontaneous formation of three-dimensional, spheroid-shaped cell conglomerates. Spheroids are then ready to be exposed to chemo-radiation protocols and immunotherapy protocols as needed. The final cell viability and spheroid size are indicators of therapy susceptibility and therefore could be drawn into consideration in future to assess the patients' likely therapy response. This model could be a valuable, cost-efficient tool towards personalized therapy for head and neck cancer.
Collapse
Affiliation(s)
- Jan Hagemann
- Department of Otorhinolaryngology, Johannes-Gutenberg University Medical Center;
| | - Christian Jacobi
- Department of Otorhinolaryngology, Technical University of Munich Medical Center
| | - Sabine Gstoettner
- Department of Otorhinolaryngology, Ludwig-Maximilian-University Medical Center
| | - Christian Welz
- Department of Otorhinolaryngology, University of Goettingen Medical Center
| | | | - Roland Stauber
- Department of Otorhinolaryngology, Johannes-Gutenberg University Medical Center
| | - Sebastian Strieth
- Department of Otorhinolaryngology, Johannes-Gutenberg University Medical Center
| | - Julian Kuenzel
- Department of Otorhinolaryngology, Johannes-Gutenberg University Medical Center
| | - Philipp Baumeister
- Department of Otorhinolaryngology, Ludwig-Maximilian-University Medical Center
| | - Sven Becker
- Department of Otorhinolaryngology, Johannes-Gutenberg University Medical Center; Department of Otorhinolaryngology, Ludwig-Maximilian-University Medical Center
| |
Collapse
|
9
|
Consoli F, Grisanti S, Amoroso V, Almici C, Verardi R, Marini M, Simoncini E. Circulating Tumor Cells as Predictors of Prognosis in Metastatic Breast Cancer: Clinical Application outside a Clinical Trial. TUMORI JOURNAL 2018; 97:737-42. [DOI: 10.1177/030089161109700610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims and Background Circulating tumor cells have a prognostic role in metastatic breast cancer. The aim of the study was to confirm the ability of circulating tumor cells, detected by the US Food and Drug Administration approved Cell Search assay, to predict the outcome of patients treated in a community general hospital. Patients and Methods. A prospective mono-institutional study was conducted at the Department of Medical Oncology at Spedali Civili, Brescia, Italy, from January 2009 to September 2010. A total of 93 consecutive patients with metastatic breast cancer were enrolled. Patients underwent a blood sample collection to detect circulating tumor cells at baseline and, subsequently, at the first follow-up examination (after 3-4 weeks from the beginning of a systemic therapy). A third sample was drawn at disease progression (at the beginning of a subsequent new course of therapy). The prognostic cutoff value of circulating tumor cells was fixed at 5 cells/7.5 ml of blood. Results At baseline, median overall survival and progression-free survival in the subgroup ≥5 circulating tumor cells/7.5 ml of blood were significantly shorter (5 months and 3 months, respectively) than in the subgroup with <5 circulating tumor cells (8 months and 7 months, respectively) (P = 0.003 and P <0.001). At the first follow-up, the subgroup with more than 5 circulating tumor cells/7.5 ml of blood had a median overall survival of 4 months versus 8 months in the subgroup with <5 circulating tumor cells (P <0.001) and a median progression-free survival of 3 months versus 7 months respectively (P <0.001). At multivariate analysis, the level of circulating tumor cells at the first follow-up and at baseline remained significant as a predictor of progression-free and overall survival. The number of metastatic sites was significantly associated with overall and progression-free survival and correlated with the number of circulating tumor cells. Conclusions Our study confirms the role of circulating tumor cells as predictors of prognosis in metastatic breast cancer patients treated in general clinical practice.
Collapse
Affiliation(s)
- Francesca Consoli
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | - Camillo Almici
- Department of Transfusion Medicine and Immunohaematology, Azienda Spedali Civili, Brescia, Italy
| | - Rosanna Verardi
- Department of Transfusion Medicine and Immunohaematology, Azienda Spedali Civili, Brescia, Italy
| | - Mirella Marini
- Department of Transfusion Medicine and Immunohaematology, Azienda Spedali Civili, Brescia, Italy
| | - Edda Simoncini
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| |
Collapse
|
10
|
Breast Carcinoma: From Initial Tumor Cell Detachment to Settlement at Secondary Sites. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8534371. [PMID: 28785589 PMCID: PMC5529633 DOI: 10.1155/2017/8534371] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/11/2017] [Accepted: 06/08/2017] [Indexed: 02/08/2023]
Abstract
Metastasis represents a multistep cascade of cancer cell alterations accompanied by structural and functional changes within the tumor microenvironment which may involve the induction of a retrodifferentiation program. Major steps in metastatic developments include (A) cell detachment from the primary tumor site involving epithelial-mesenchymal transition (EMT), (B) migration and invasion into surrounding tissue, (C) transendothelial intravasation into the vasculature of blood and/or lymphatic vessels as circulating tumor cells (CTCs), (D) dissemination to distant organs, and (E) extravasation of CTCs to secondary sites as disseminated tumor cells (DTCs). This article highlights some aspects of the metastatic cascade with a focus on breast cancer cells. Metastatic steps critically depend on the capability of cancer cells to adapt to distant tissues and the corresponding new microenvironment. As a consequence, increasing plasticity and developmental changes paralleled by acquisition of new cancer cell functionalities challenge a successful therapeutic approach.
Collapse
|
11
|
Zhang Y, Lv Y, Niu Y, Su H, Feng A. Role of Circulating Tumor Cell (CTC) Monitoring in Evaluating Prognosis of Triple-Negative Breast Cancer Patients in China. Med Sci Monit 2017. [PMID: 28643770 PMCID: PMC5493060 DOI: 10.12659/msm.902637] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Breast cancer (BC) is the most common malignant tumor in females. This study investigated the role and utility of CTC monitoring in evaluating the prognosis of triple-negative breast cancer patients. Material/Methods We enrolled 286 female triple-negative breast cancer patients who were diagnosed at and received radical resection surgery in our hospital. Peripheral venous blood samples were collected preoperatively and at 3 and 7 days postoperative, and the Cell Search system was used to detect CTC in peripheral blood. We analyzed the relationship between preoperative CTC level and clinical pathological characteristics of patients. Kaplan-Meier method was used to establish progression-free survival curves and overall survival curves, we used the log-rank test to compare the survival rate, and we explored the effects of preoperative and postoperative CTC levels on patient survival. Results Compared with preoperative levels, the average CTC content in peripheral blood of breast cancer patients was significantly increased at 3 days after surgery, and then decreased to the preoperative baseline level by 7 days after surgery. The 3-year overall survival rate and progression-free survival rate in patients with CTC >5/7.5 mL peripheral blood were significantly lower than in patients with CTC <5/7.5 mL peripheral blood detected preoperatively and at 3 and 7 days postoperatively. Conclusions Dynamic monitoring of preoperative and postoperative CTC levels can accurately predict recurrence and progression of disease, and is important in postoperative monitoring and prognosis evaluation.
Collapse
Affiliation(s)
- Yanwu Zhang
- Department of Breast Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Yidong Lv
- Department of Breast Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Yaodong Niu
- Department of Breast Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Hongge Su
- Department of Breast Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Aiqiang Feng
- Department of Breast Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Mansi J, Morden J, Bliss JM, Neville M, Coombes RC. Bone marrow micrometastases in early breast cancer-30-year outcome. Br J Cancer 2016; 114:243-7. [PMID: 26766739 PMCID: PMC4742582 DOI: 10.1038/bjc.2015.447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Micrometastases in bone marrow of women with early breast cancer were first identified immunocytochemically in the 1980s. We report on the original cohort of women with a median follow-up of 30 years. PATIENTS AND METHODS In total, 350 women with primary breast cancer had eight bone marrow aspirates examined with antibody to epithelial membrane antigen. Data on long-term mortality were obtained via record linkage to death certification. RESULTS At a 30-year median follow-up, 79 out of 89 (89%) patients with micrometastases have died compared with 202 out of 261 (77%) without (hazard ratio=1.46 (95% CI 1.12-1.90), P=0.0043). Most marked effect of micrometastases on overall survival (OS) was seen in patients aged ⩽ 50 at surgery (N=97, P=0.012), and on all patients within 10 years of diagnosis. In multivariable analyses, the presence of micrometastases was no longer a statistically significant prognostic factor. CONCLUSIONS Bone marrow micrometastases are predictive for OS, particularly in the first decade and in younger patients.
Collapse
Affiliation(s)
- J Mansi
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, SE1 9RT, UK
| | - J Morden
- ICR Clinical Trials & Statistics Unit (ICR-CTSU), Division of Clinical Studies, The Institute of Cancer Research, London, SM2 5NG, UK
| | - J M Bliss
- ICR Clinical Trials & Statistics Unit (ICR-CTSU), Division of Clinical Studies, The Institute of Cancer Research, London, SM2 5NG, UK
| | - M Neville
- Ludwig Institute for Cancer Research, New York, NY 10158, USA
| | - R C Coombes
- Division of Cancer, Imperial College London, London, W12 0NN, UK
| |
Collapse
|
14
|
Sayed M, Zahran A, Hassan M, Mohamed D. Circulating Tumor Cells and Cancer Stem Cells: Clinical Implications in Nonmetastatic Breast Cancer. BREAST CANCER: BASIC AND CLINICAL RESEARCH 2016; 10:10.4137_BCBCR.S40856. [PMID: 35173437 PMCID: PMC8842436 DOI: 10.4137/bcbcr.s40856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Despite the therapeutic advances, disease recurrence remains an ever-present threat to the health and well-being of breast cancer survivors. Assessment of circulating tumor cells (CTCs) and cancer stem cells (CSCs) during and after treatment may be of value in refining treatment. Methods Three 5 mL blood samples were taken from each patient: the first, at diagnosis; the second, after completion of neoadjuvant anthracyclin-based chemotherapy; and the third, a month after surgery and completion of adjuvant radiotherapy. The absolute numbers of CTCs were identified as CD45-cytokeratin+ cells. CTCs per 5 mL of blood were determined by recording all events in the whole suspension. CSCs were identified as cytokeratin+CD44+CD24-/CD45- cells. The CSCs were expressed as a percentage of CTCs. Results Univariate analysis identified the measurements of baseline CTCs and CSCs, taken after chemotherapy and one month after the cessation of radiotherapy, as prognostic factors for both four-year disease-free survival and four-year overall survival. Multivariable analysis identified the third measurement of CSCs, taken one month after the completion of radiotherapy, as the only independent prognostic factor for the four-year disease-free survival (P < 0.002, hazard ratio [HR] = 1.231, 95% CI 1.077–1.407). The initial CTC measurement was the one factor that reached significance on multivariate analysis (P < 0.03, HR 1.969, 95% CI 1.092–3.551) for the four-year overall survival. Correlation was higher between CTC and CSC counts at diagnosis (r = 0.654, P < 0.001) than after chemotherapy (r = 0.317, P < 0.03), because of the more rapid decrease in the mean CTC count with chemotherapy. Conclusion The CTC count could be suitable as one of the measures for monitoring response to chemotherapy, while persistence of CSC after cessation of the treatment of nonmetastatic breast cancer, except hormonal therapy when indicated, may be a reason to consider additional therapy in the future. These findings need confirmation in larger randomized trials.
Collapse
Affiliation(s)
- M. Sayed
- Department of Radiation Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - A.M. Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - M.S.F. Hassan
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - D.O. Mohamed
- Department of Radiation Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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.
Collapse
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
| | | |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Spiliotaki M, Mavroudis D, Kapranou K, Markomanolaki H, Kallergi G, Koinis F, Kalbakis K, Georgoulias V, Agelaki S. Evaluation of proliferation and apoptosis markers in circulating tumor cells of women with early breast cancer who are candidates for tumor dormancy. Breast Cancer Res 2014; 16:485. [PMID: 25432416 PMCID: PMC4303210 DOI: 10.1186/s13058-014-0485-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 11/17/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction Clinical dormancy is frequently observed in breast cancer. In the present study, we aimed to characterize circulating tumor cells (CTCs) in dormancy candidates (DC) with early breast cancer in terms of proliferation and apoptosis. Methods Cytospins of peripheral blood mononuclear cells (PBMCs) were obtained from DC (n = 122) who were disease-free for at least 5 years and from metastatic patients (n = 40) who relapsed more than 5 years after surgery. Sequential samples from eight DC (n = 36) who maintained a prolonged disease-free status and from eight DC (n = 27) presenting late relapse during follow-up, were also analyzed. PBMCs were triple stained with a pancytokeratin, antibody along with anti-Ki67 and anti-M30 antibodies as proliferation and apoptosis markers, respectively. Results CTCs were identified in 40 (33%) of 122 DC and in 15 (37.5%) of 40 metastatic patients. In total, twenty-five (62.5%) DC had exclusively dormant (Ki67(-)/M30(-)), seven (17.5%) had proliferative Ki67(+)/M30(-), four (10%) had apoptotic Ki67(-)/M30(+) and four (10%) had both phenotypes of proliferative and apoptotic CTCs. In comparison, 53.4% of CTC-positive metastatic patients had exclusively dormant and 46.6% had proliferative CTCs; none had apoptotic CTCs (P = 0.039). Among all CTCs detected in DC patients, 82.4% were dormant, whereas in the nondormant population, 32.5% were proliferative and 67.5% apoptotic. The respective percentages in metastatic patients were 59.1%, 100% and 0% (P <0.0001). Moreover, apoptotic CTCs prevailed among nondormant CTCs detected in sequential samples from DC who remained in a prolonged disease-free status compared to those presenting late relapse during follow-up (70.6% versus 43.5% (P = 0.0002)). Conclusions The apoptotic index of CTCs is increased during clinical dormancy, whereas the proliferation index is increased on relapse. In addition, apoptotic CTCs are more frequently encountered during follow-up in DC patients who remain disease-free compared to those with subsequent late relapse, suggesting that monitoring proliferation and apoptosis in CTCs during clinical dormancy merits further investigation as a tool for predicting late disease recurrence. Electronic supplementary material The online version of this article (doi:10.1186/s13058-014-0485-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maria Spiliotaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece.
| | - Dimitris Mavroudis
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece. .,Department of Medical Oncology, University General Hospital of Heraklion, Voutes, P.O BOX 1352, Heraklion, 71110, Crete, Greece.
| | - Kyriaki Kapranou
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece.
| | - Harris Markomanolaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece.
| | - Galatea Kallergi
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece.
| | - Filippos Koinis
- Department of Medical Oncology, University General Hospital of Heraklion, Voutes, P.O BOX 1352, Heraklion, 71110, Crete, Greece.
| | - Kostas Kalbakis
- Department of Medical Oncology, University General Hospital of Heraklion, Voutes, P.O BOX 1352, Heraklion, 71110, Crete, Greece.
| | - Vassilis Georgoulias
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece. .,Department of Medical Oncology, University General Hospital of Heraklion, Voutes, P.O BOX 1352, Heraklion, 71110, Crete, Greece.
| | - Sofia Agelaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Voutes University Campus, Heraklion, 71003, Crete, Greece. .,Department of Medical Oncology, University General Hospital of Heraklion, Voutes, P.O BOX 1352, Heraklion, 71110, Crete, Greece.
| |
Collapse
|
19
|
Bork U, Grützmann R, Rahbari NN, Schölch S, Distler M, Reissfelder C, Koch M, Weitz J. Prognostic relevance of minimal residual disease in colorectal cancer. World J Gastroenterol 2014; 20:10296-10304. [PMID: 25132746 PMCID: PMC4130837 DOI: 10.3748/wjg.v20.i30.10296] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/18/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Presence of occult minimal residual disease in patients with colorectal cancer (CRC) has a strong prognostic impact on survival. Minimal residual disease plays a major role in disease relapse and formation of metastases in CRC. Analysis of circulating tumor cells (CTC) in the blood is increasingly used in clinical practice for disease monitoring of CRC patients. In this review article the role of CTC, disseminated tumor cells (DTC) in the bone marrow and micrometastases and isolated tumor cells (ITC) in the lymph nodes will be discussed, including literature published until September 2013. Occult disease is a strong prognostic marker for patient survival in CRC and defined by the presence of CTC in the blood, DTC in the bone marrow and/or micrometastases and ITC in the lymph nodes. Minimal residual disease could be used in the future to identify patient groups at risk, who might benefit from individualized treatment options.
Collapse
|
20
|
Wolfrom CM, Laurent M, Deschatrette J. Can we negotiate with a tumor? PLoS One 2014; 9:e103834. [PMID: 25084359 PMCID: PMC4118912 DOI: 10.1371/journal.pone.0103834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/08/2014] [Indexed: 12/18/2022] Open
Abstract
Recent progress in deciphering the molecular portraits of tumors promises an era of more personalized drug choices. However, current protocols still follow standard fixed-time schedules, which is not entirely coherent with the common observation that most tumors do not grow continuously. This unpredictability of the increases in tumor mass is not necessarily an obstacle to therapeutic efficiency, particularly if tumor dynamics could be exploited. We propose a model of tumor mass evolution as the integrated result of the dynamics of two linked complex systems, tumor cell population and tumor microenvironment, and show the practical relevance of this nonlinear approach.
Collapse
Affiliation(s)
- Claire M. Wolfrom
- Equipe « Dynamiques cellulaires et modélisation », Inserm Unité 757, Université Paris-Sud, Orsay, France
| | - Michel Laurent
- Equipe « Dynamiques cellulaires et modélisation », Inserm Unité 757, Université Paris-Sud, Orsay, France
| | - Jean Deschatrette
- Equipe « Dynamiques cellulaires et modélisation », Inserm Unité 757, Université Paris-Sud, Orsay, France
| |
Collapse
|
21
|
Prevention of Bone Metastases in Breast Cancer Patients. Therapeutic Perspectives. J Clin Med 2014; 3:521-36. [PMID: 26237389 PMCID: PMC4449698 DOI: 10.3390/jcm3020521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 01/13/2023] Open
Abstract
One in four breast cancer patients is at risk of developing bone metastases in her life time. The early prevention of bone metastases is a crucial challenge. It has been suggested that the use of zoledronic acid (ZOL) in the adjuvant setting may reduce the persistence of disseminated tumor cells and thereby might improve outcome, specifically in a population of patients with a low estrogen microenvironment. More recently, the results of a large meta-analysis from 41 randomized trials comparing a bisphosphonate (BP) to placebo or to an open control have been presented at the 2013 San Antonio Breast Cancer Meeting. Data on 17,016 patients confirm that adjuvant BPs, irrespective of the type of treatment or the treatment schedule and formulation (oral or intra-venously (IV)), significantly reduced bone recurrences and improved breast cancer survival in postmenopausal women. No advantage was seen in premenopausal women. BPs are soon likely to become integrated into standard practice. Published data on the mechanisms involved in tumor cell seeding from the primary site, in homing to bone tissues and in the reactivation of dormant tumor cells will be reviewed; these might offer new ideas for innovative combination strategies.
Collapse
|
22
|
Turker I, Uyeturk U, Sonmez OU, Oksuzoglu B, Helvaci K, Arslan UY, Budakoglu B, Alkis N, Aksoy S, Zengin N. Detection of circulating tumor cells in breast cancer patients: prognostic predictive role. Asian Pac J Cancer Prev 2014; 14:1601-7. [PMID: 23679243 DOI: 10.7314/apjcp.2013.14.3.1601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A determination of circulating tumor cell (CTC) effectiveness for prediction of progression-free survival (PFS) and overall survival (OS) was conducted as an adjunct to standard treatment of care in breast cancer management. Between November 2008 and March 2009, 22 metastatic and 12 early stage breast carcinoma patients, admitted to Ankara Oncology Training and Research Hospital, were included in this prospective trial. Patients' characteristics, treatment schedules and survival data were evaluated. CTC was detected twice by CellSearch method before and 9-12 weeks after the initiation of chemotherapy. A cut-off value equal or greater than 5 cells per 7.5 ml blood sample was considered positive. All patients were female. Median ages were 48.0 (range: 29-65) and 52.5 (range: 35-66) in early stage and metastatic subgroups, respectively. CTC was positive in 3 (13.6%) patients before chemotherapy and 6 (27.3%) patients during chemotherapy in the metastatic subgroup whereas positive in only one patient in the early stage subgroup before and during chemotherapy. The median follow-up was 22.0 (range: 21-23) and 19.0 (range: 5-23) months in the early stage and metastatic groups, respectively. In the metastatic group, both median PFS and OS were significantly shorter in any time CTC positive patients compared to CTC negative patients (PFS: 4.0 vs 14.0 months, Log-Rank p=0.013; and OS: 8.0 months vs. 20.5 months, Log-Rank p<0.001). OS was affected from multiple visceral metastatic sites (p=0.055) and higher grade (p=0.044) besides CTC positivity (log rank p<0.001). Radiological response of chemotherapy was also correlated with better survival (p<0.001). As a result, CTC positivity was confirmed as a prospective marker even in a small patient population, in this single center study. Measurement of CTC by CellSearch method in metastatic breast carcinoma cases may allow indications of early risk of relapse or death with even as few as two measurements during a chemotherapy program, but this finding should be confirmed with prospective trials in larger study populations.
Collapse
Affiliation(s)
- Ibrahim Turker
- Medical Oncology Department, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Conteduca V, Zamarchi R, Rossi E, Condelli V, Troiani L, Aieta M. Circulating tumor cells: utopia or reality? Future Oncol 2013; 9:1337-52. [DOI: 10.2217/fon.13.101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Circulating tumor cells (CTCs) could be considered a sign of tumor aggressiveness, but highly sensitive and specific methods of CTC detection are necessary owing to the rarity and heterogeneity of CTCs in peripheral blood. This review summarizes recent studies on tumor biology, with particular attention to the metastatic cascade, and the molecular characterization and clinical significance of CTCs. Recent technological approaches to enrich and detect these cells and challenges of CTCs for individualized cancer treatment are also discussed. This review also provides an insight into the positive and negative features of the future potential applications of CTC detection, which sometimes remains still a ‘utopia’, but its actual utility remains among the fastest growing research fields in oncology.
Collapse
Affiliation(s)
- Vincenza Conteduca
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Via Piero Maroncelli 40, 47014 Meldola (FC), Italy
| | | | - Elisabetta Rossi
- Department of Surgery, Oncology & Gastroenterology, Oncology Section, University of Padova, Italy
| | - Valentina Condelli
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy
| | - Laura Troiani
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy
| | - Michele Aieta
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy
| |
Collapse
|
24
|
Wang L, Asghar W, Demirci U, Wan Y. Nanostructured substrates for isolation of circulating tumor cells. NANO TODAY 2013; 8:347-387. [PMID: 24944563 PMCID: PMC4059613 DOI: 10.1016/j.nantod.2013.07.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Circulating tumor cells (CTCs) originate from the primary tumor mass and enter into the peripheral bloodstream. CTCs hold the key to understanding the biology of metastasis and also play a vital role in cancer diagnosis, prognosis, disease monitoring, and personalized therapy. However, CTCs are rare in blood and hard to isolate. Additionally, the viability of CTCs can easily be compromised under high shear stress while releasing them from a surface. The heterogeneity of CTCs in biomarker expression makes their isolation quite challenging; the isolation efficiency and specificity of current approaches need to be improved. Nanostructured substrates have emerged as a promising biosensing platform since they provide better isolation sensitivity at the cost of specificity for CTC isolation. This review discusses major challenges faced by CTC isolation techniques and focuses on nanostructured substrates as a platform for CTC isolation.
Collapse
Affiliation(s)
- Lixue Wang
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, Nanjing, Jiangsu 210003, PR China
| | - Waseem Asghar
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratories, Center for Biomedical Engineering, Renal Division and Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Utkan Demirci
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratories, Center for Biomedical Engineering, Renal Division and Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Harvard-Massachusetts Institute of Technology (MIT), Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Yuan Wan
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, Nanjing, Jiangsu 210003, PR China
- Ian Wark Research Institute, University of South Australia, Mawson Lakes, Adelaide, SA 5095, Australia
| |
Collapse
|
25
|
Banys M, Müller V, Melcher C, Aktas B, Kasimir-Bauer S, Hagenbeck C, Hartkopf A, Fehm T. Circulating tumor cells in breast cancer. Clin Chim Acta 2013; 423:39-45. [DOI: 10.1016/j.cca.2013.03.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 01/02/2023]
|
26
|
SONG GUOQING, ZHAO YI. Different therapeutic effects of distinct KISS1 fragments on breast cancer in vitro and in vivo. Int J Oncol 2013; 43:1219-27. [DOI: 10.3892/ijo.2013.2029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/07/2013] [Indexed: 11/06/2022] Open
|
27
|
Schindlbeck C, Andergassen U, Hofmann S, Jückstock J, Jeschke U, Sommer H, Friese K, Janni W, Rack B. Comparison of circulating tumor cells (CTC) in peripheral blood and disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients. J Cancer Res Clin Oncol 2013; 139:1055-62. [DOI: 10.1007/s00432-013-1418-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/06/2013] [Indexed: 11/28/2022]
|
28
|
Mathiesen RR, Borgen E, Renolen A, Løkkevik E, Nesland JM, Anker G, Ostenstad B, Lundgren S, Risberg T, Mjaaland I, Kvalheim G, Lønning PE, Naume B. Persistence of disseminated tumor cells after neoadjuvant treatment for locally advanced breast cancer predicts poor survival. Breast Cancer Res 2012; 14:R117. [PMID: 22889108 PMCID: PMC3680942 DOI: 10.1186/bcr3242] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/14/2012] [Indexed: 12/21/2022] Open
Abstract
Introduction Presence of disseminated tumor cells (DTCs) in bone marrow (BM) and circulating tumor cells (CTC) in peripheral blood (PB) predicts reduced survival in early breast cancer. The aim of this study was to determine the presence of and alterations in DTC- and CTC-status in locally advanced breast cancer patients undergoing neoadjuvant chemotherapy (NACT) and to evaluate their prognostic impact. Methods Bone marrow and peripheral blood were collected before NACT (BM1: n = 231/PB1: n = 219), at surgery (BM2: n = 69/PB2: n = 71), and after 12 months from start of NACT (BM3: n = 162/PB3: n = 141). Patients were included from 1997 to 2003 and followed until 2009 (or ten years follow-up). DTC- and CTC-status were determined by morphological evaluation of immunocytochemically detected cytokeratin-positive cells. The prognostic significance of DTCs/CTCs was assessed by univariate and multivariate Cox-regression analyses. Results Before NACT, DTCs and CTCs were detected in 21.2% and 4.9% of the patients, respectively. At surgery, 15.9% and 1.4% had DTC- and CTC-presence, compared to 26.5% and 4.3% at 12 months from start of NACT. Of patients for whom DTC results both before NACT and at 12 months were available, concordant results were observed in 68%, and 14 out of 65 had positive DTC-status at both time points. Presence of ≥ 1 DTC 12 months from start of NACT, but not at other time points, predicted reduced disease-free survival (DFS; HR 2.3, p = 0.003), breast cancer-specific survival (BCSS; HR 3.0, p < 0.001) and overall survival (OS; HR 2.8, p < 0.001). Before NACT, presence of ≥ 3 DTCs was also associated with unfavorable outcome, and reduced BCSS was observed for CTC-positive patients (HR 2.2, p = 0.046). In multivariate analysis, DTC status (</≥ 1 DTC) at 12 months after start of NACT remained as a prognostic factor for both DFS (HR 2.2, p = 0.005), BCSS (HR 2.6, p = 0.002) and OS (HR 2.6, p = 0.002). The survival for patients with change in DTC-status was determined by the DTC-status at 12 months. Conclusion Presence of DTCs after NACT indicated high risk for relapse and death, irrespective of the DTC-status before treatment. The results supports the potential use of DTC analysis as a monitoring tool during follow up, for selection of patients to secondary treatment intervention within clinical trials.
Collapse
|
29
|
Affiliation(s)
- Jonathan Krell
- Division of Cancer, Department of Surgery and Cancer, Imperial College, London, UK
| | | |
Collapse
|
30
|
Lucci A, Hall CS, Lodhi AK, Bhattacharyya A, Anderson AE, Xiao L, Bedrosian I, Kuerer HM, Krishnamurthy S. Circulating tumour cells in non-metastatic breast cancer: a prospective study. Lancet Oncol 2012; 13:688-95. [PMID: 22677156 DOI: 10.1016/s1470-2045(12)70209-7] [Citation(s) in RCA: 379] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The identification of circulating tumour cells correlate with poor prognosis in metastatic breast cancer, but there are few data describing the importance of circulating tumour cells in patients with non-metastatic disease. Our aim was to establish if circulating tumour cells predicted worse outcome in patients with non-metastatic breast cancer. METHODS We prospectively collected data on circulating tumour cells at the time of definitive surgery from chemonaive patients with stage 1-3 breast cancer from February, 2005, to December, 2010. We deemed eligible all patients with operable breast cancer presenting at The University of Texas MD Anderson Cancer Center (Houston, TX, USA). Patients were ineligible if they had bilateral breast cancer or any other malignancy within 5 years of the diagnosis of the present cancer. We measured circulating tumour cells with the CellSearch System (Veridex, Raritan, NJ). We correlated findings of circulating tumour cells with standard tumour characteristics, including tumour size and grade; oestrogen and progesterone receptor and human epidural growth factor receptor 2 (HER2) status; and axillary lymph node status with χ(2) or Fisher exact tests. We assessed outcomes at a median follow-up of 35 months. Log-rank test and Cox regression analysis was applied to establish the association of circulating tumour cells with progression-free and overall survival. FINDINGS No patients reported adverse events or complications from blood collections. We identified one or more circulating tumour cells in 73 (24%) of 302 patients. Detection of one or more circulating tumour cells predicted both decreased progression-free survival (log-rank p=0·005; hazard ratio [HR] 4·62, 95% CI 1·79-11·9) and overall survival (log-rank p=0·01; HR 4·04, 1·28-12·8). INTERPRETATION The presence of one or more circulating tumour cells predicted early recurrence and decreased overall survival in chemonaive patients with non-metastatic breast cancer. These results suggest that assessment of circulating tumour cells might provide important prognostic information in these patients. FUNDING Society of Surgical Oncology, Morgan Welch Inflammatory Breast Cancer Program, The University of Texas MD Anderson Cancer Center, and the State of Texas Rare and Aggressive Breast Cancer Research Program.
Collapse
Affiliation(s)
- Anthony Lucci
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Eckhardt BL, Francis PA, Parker BS, Anderson RL. Strategies for the discovery and development of therapies for metastatic breast cancer. Nat Rev Drug Discov 2012; 11:479-97. [PMID: 22653217 DOI: 10.1038/nrd2372] [Citation(s) in RCA: 255] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nearly all deaths caused by solid cancers occur as a result of metastasis--the formation of secondary tumours in distant organs such as the lungs, liver, brain and bone. A major obstruction to the development of drugs with anti-metastatic efficacy is our fragmented understanding of how tumours 'evolve' and metastasize, at both the biological and genetic levels. Furthermore, although there is significant overlap in the metastatic process among different types of cancer, there are also marked differences in the propensity to metastasize, the extent of metastasis, the sites to which the tumour metastasizes, the kinetics of the process and the mechanisms involved. Here, we consider the case of breast cancer, which has some marked distinguishing features compared with other types of cancer. Considerable progress has been made in the development of preclinical models and in the identification of relevant signalling pathways and genetic regulators of metastatic breast cancer, and we discuss how these might facilitate the development of novel targeted anti-metastatic drugs.
Collapse
Affiliation(s)
- Bedrich L Eckhardt
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | |
Collapse
|
32
|
Shamash J, Jacob J, Agrawal S, Powles T, Mutsvangwa K, Wilson P, Stebbing J. Whole blood stem cell reinfusion and escalated dose melphalan in castration-resistant prostate cancer: a phase 1 study. Clin Cancer Res 2012; 18:2352-9. [PMID: 22392912 DOI: 10.1158/1078-0432.ccr-11-3293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Nontaxane-based chemotherapeutic options in castrate-resistant prostate cancer (CRPC) are limited despite the long natural history of the disease. We carried out a phase 1 dose-escalation study of the alkylating agent melphalan with autologous stem cell transplantation, comparing rapid changes in circulating tumor cells (CTC) and prostate-specific antigen (PSA) as a measure of response. EXPERIMENTAL DESIGN Cohorts of individuals with advanced CRPC received high-dose intravenous melphalan, and autologous blood was returned to patients during treatment. The efficacy endpoints were the PSA reduction rate, CTC response, survival parameters, toxicity and whether reinduction of endocrine sensitivity occurred. RESULTS Twenty-four patients were recruited. Dose escalation was feasible with the highest dose cohort being reached. Of 23 individuals evaluable for response, 16 had a PSA response of more than 30%; of 11 patients with soft tissue disease, 4 achieved a partial response and 7 had stable disease. Patients with CTC counts that decreased to less than 5 within 2 weeks from the start of therapy had a longer overall survival (30.6 months vs. 15.3 months, P = 0.03) Treatment was associated with myelosuppression and frequent hospitalizations. In 20 patients after the study, hormone therapy was reintroduced when PSA increased again; response rates were high. CONCLUSIONS Autologous transplantation following high-dose alkylating agent chemotherapy induces responses but proved toxic, although dose escalation proved possible. The possibility of using CTCs to identify responders at two weeks may be used to justify such an intensive approach. Many individuals went on to further respond to both docetaxel and hormonal therapy.
Collapse
Affiliation(s)
- Jonathan Shamash
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
33
|
Shaw JA, Page K, Blighe K, Hava N, Guttery D, Ward B, Brown J, Ruangpratheep C, Stebbing J, Payne R, Palmieri C, Cleator S, Walker RA, Coombes RC. Genomic analysis of circulating cell-free DNA infers breast cancer dormancy. Genome Res 2012; 22:220-31. [PMID: 21990379 PMCID: PMC3266030 DOI: 10.1101/gr.123497.111] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/16/2011] [Indexed: 11/24/2022]
Abstract
Biomarkers in breast cancer to monitor minimal residual disease have remained elusive. We hypothesized that genomic analysis of circulating free DNA (cfDNA) isolated from plasma may form the basis for a means of detecting and monitoring breast cancer. We profiled 251 genomes using Affymetrix SNP 6.0 arrays to determine copy number variations (CNVs) and loss of heterozygosity (LOH), comparing 138 cfDNA samples with matched primary tumor and normal leukocyte DNA in 65 breast cancer patients and eight healthy female controls. Concordance of SNP genotype calls in paired cfDNA and leukocyte DNA samples distinguished between breast cancer patients and healthy female controls (P < 0.0001) and between preoperative patients and patients on follow-up who had surgery and treatment (P = 0.0016). Principal component analyses of cfDNA SNP/copy number results also separated presurgical breast cancer patients from the healthy controls, suggesting specific CNVs in cfDNA have clinical significance. We identified focal high-level DNA amplification in paired tumor and cfDNA clustered in a number of chromosome arms, some of which harbor genes with oncogenic potential, including USP17L2 (DUB3), BRF1, MTA1, and JAG2. Remarkably, in 50 patients on follow-up, specific CNVs were detected in cfDNA, mirroring the primary tumor, up to 12 yr after diagnosis despite no other evidence of disease. These data demonstrate the potential of SNP/CNV analysis of cfDNA to distinguish between patients with breast cancer and healthy controls during routine follow-up. The genomic profiles of cfDNA infer dormancy/minimal residual disease in the majority of patients on follow-up.
Collapse
Affiliation(s)
- Jacqueline A Shaw
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester LE2 7LX, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kasimir-Bauer S, Hoffmann O, Wallwiener D, Kimmig R, Fehm T. Expression of stem cell and epithelial-mesenchymal transition markers in primary breast cancer patients with circulating tumor cells. Breast Cancer Res 2012; 14:R15. [PMID: 22264265 PMCID: PMC3496132 DOI: 10.1186/bcr3099] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/31/2011] [Accepted: 01/20/2012] [Indexed: 01/16/2023] Open
Abstract
Introduction The presence of circulating tumor cells (CTC) in breast cancer might be associated with stem cell-like tumor cells which have been suggested to be the active source of metastatic spread in primary tumors. Furthermore, to be able to disseminate and metastasize, CTC must be able to perform epithelial-mesenchymal transition (EMT). We studied the expression of three EMT markers and the stem cell marker ALDH1 in CTC from 502 primary breast cancer patients. Data were correlated with the presence of disseminated tumor cells (DTC) in the bone marrow (BM) and with clinicopathological data of the patients. Methods A total of 2 × 5 ml of blood was analyzed for CTC with the AdnaTest BreastCancer (AdnaGen AG) for the detection of EpCAM, MUC-1, HER2 and beta-Actin transcripts. The recovered c-DNA was additionally multiplex tested for three EMT markers [TWIST1, Akt2, phosphoinositide kinase-3 (PI3Kα)] and separately for the tumor stem cell marker ALDH1. The identification of EMT markers was considered positive if at least one marker was detected in the sample. Two BM aspirates from all patients were analyzed for DTC by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. Results Ninety-seven percent of 30 healthy donor samples investigated were negative for EMT and 95% for ALDH1 transcripts, respectively. CTC were detected in 97/502 (19%) patients. At least one of the EMT markers was expressed in 29% and ALDH1 was present in 14% of the samples, respectively. Interestingly, 5% of the ALDH1-positive and 18% of the EMT-positive patients were CTC-negative based on the cut-off level determined for CTC-positivity applying the AdnaTest BreastCancer. DTC in the BM were detected in 107/502 (21%) patients and no correlation was found between BM status and CTC positivity (P = 0.41). The presence of CTC, EMT and ALDH1 expression was not correlated to any of the prognostic clinical markers. Conclusions Our data indicate that (1) a subset of primary breast cancer patients shows EMT and stem cell characteristics and (2) the currently used detection methods for CTC are not efficient to identify a subtype of CTC which underwent EMT. (3) The clinical relevance on prognosis and therapy response has to be further evaluated in a prospective trial.
Collapse
Affiliation(s)
- Sabine Kasimir-Bauer
- Department of Gynecology and Obstetrics, University Hospital of Essen, University of Duisburg-Essen, D-45122 Essen, Germany.
| | | | | | | | | |
Collapse
|
35
|
Payne RE, Hava NL, Page K, Blighe K, Ward B, Slade M, Brown J, Guttery DS, Zaidi SAA, Stebbing J, Jacob J, Yagüe E, Shaw JA, Coombes RC. The presence of disseminated tumour cells in the bone marrow is inversely related to circulating free DNA in plasma in breast cancer dormancy. Br J Cancer 2012; 106:375-82. [PMID: 22166803 PMCID: PMC3261674 DOI: 10.1038/bjc.2011.537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/29/2011] [Accepted: 11/10/2011] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of this study was to gain insight into breast cancer dormancy by examining different measures of minimal residual disease (MRD) over time in relation to known prognostic factors. METHODS Sixty-four primary breast cancer patients on follow-up (a median of 8.3 years post surgery) who were disease free had sequential bone marrow aspirates and blood samples taken for the measurement of disseminated tumour cells (DTCs), circulating tumour cells (CTCs) by CellSearch and qPCR measurement of overlapping (96-bp and 291-bp) amplicons in circulating free DNA (cfDNA). RESULTS The presence of CTCs was correlated with the presence of DTCs measured by immunocytochemistry (P=0.01) but both were infrequently detected. Increasing cfDNA concentration correlated with ER, HER2 and triple-negative tumours and high tumour grade, and the 291-bp amplicon was inversely correlated with DTCs measured by CK19 qRT-PCR (P=0.047). CONCLUSION Our results show that breast cancer patients have evidence of MRD for many years after diagnosis despite there being no overt evidence of disease. The inverse relationship between bone marrow CK19 mRNA and the 291-bp amplicon in cfDNA suggests that an inverse relationship between a measure of cell viability in the bone marrow (DTCs) and cell death in the plasma occurs during the dormancy phase of breast cancer.
Collapse
Affiliation(s)
- R E Payne
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - N L Hava
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - K Page
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - K Blighe
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - B Ward
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF, UK
| | - M Slade
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - J Brown
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - D S Guttery
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - S A A Zaidi
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - J Stebbing
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - J Jacob
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - E Yagüe
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| | - J A Shaw
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - R C Coombes
- Division of Cancer, Imperial College, MRC Cyclotron Building, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
| |
Collapse
|
36
|
Alsamarai S, Abu-Khalaf MM, Harris LN. DTCs/CTCs in breast cancer: five decades later. Recent Results Cancer Res 2012; 195:217-225. [PMID: 22527509 DOI: 10.1007/978-3-642-28160-0_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Since circulating tumor cells were first reported in 1955, the field has seen major advances in their detection and has established their prognostic impact. Here we review the current evidence for the prognostic and predictive value of circulating tumor cells in metastatic breast cancer. We then evaluate the role of CTCs and DTCs in early stage breast cancer. The weight of the evidence supports the role of CTCs and DTCs as prognostic indicators, however their role in therapy prediction remains unclear. Ongoing trials may provide answers and newer detection methods which improve sensitivity and specificity may have greater impact. At this point, the data does not support incorporation into clinical practice for early breast cancer patients.
Collapse
|
37
|
Bednarz-Knoll N, Alix-Panabières C, Pantel K. Clinical relevance and biology of circulating tumor cells. Breast Cancer Res 2011; 13:228. [PMID: 22114869 PMCID: PMC3326546 DOI: 10.1186/bcr2940] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Most breast cancer patients die due to metastases, and the early onset of this multistep process is usually missed by current tumor staging modalities. Therefore, ultrasensitive techniques have been developed to enable the enrichment, detection, isolation and characterization of disseminated tumor cells in bone marrow and circulating tumor cells in the peripheral blood of cancer patients. There is increasing evidence that the presence of these cells is associated with an unfavorable prognosis related to metastatic progression in the bone and other organs. This review focuses on investigations regarding the biology and clinical relevance of circulating tumor cells in breast cancer.
Collapse
Affiliation(s)
- Natalia Bednarz-Knoll
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistr, 52, 20246 Hamburg, Germany
| | | | | |
Collapse
|
38
|
Paterlini-Bréchot P. Organ-specific markers in circulating tumor cell screening: an early indicator of metastasis-capable malignancy. Future Oncol 2011; 7:849-71. [PMID: 21732757 DOI: 10.2217/fon.11.32] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Circulating tumor cells (CTCs) represent an important biological link in the spread of primary solid tumors to the metastatic disease responsible for most cancer mortality. Their detection in the peripheral blood of patients with many different carcinomas has shown that tumor-cell dissemination can proceed at an early stage of tumor development and their presence is associated with poor clinical outcomes, particularly in metastatic disease. In this article we describe how the increasingly sensitive isolation and detailed molecular characterization of CTCs has greatly improved our understanding of metastatic proliferation. We focus on how CTC detection and knowledge of the molecular architecture of these cells can serve as biomarkers to signal metastasis-capable disseminating cells and predict therapy-specific response. This has marked clinical utility for improved selection of systemic therapies to the individual needs of a cancer patient, real-time monitoring of metastatic disease treatments and the development of new targeted therapies.
Collapse
|
39
|
Tumor angiogenesis: pericytes and maturation are not to be ignored. JOURNAL OF ONCOLOGY 2011; 2012:261750. [PMID: 22007214 PMCID: PMC3191787 DOI: 10.1155/2012/261750] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 07/05/2011] [Indexed: 12/25/2022]
Abstract
Angiogenesis, an essential component of tumor growth and survival, is regulated by complex interactions between several cell types and soluble mediators. Heterogeneous tumor vasculature originates from the collective effect of the nature of carcinoma and the complexity of the angiogenic network. Although the application of angiogenesis inhibitors in some types of cancers has shown clinical benefits, predictive markers to assess treatment effects have yet to be established. In this review, we focus on tumor vessel maturity as a potential marker for evaluating treatment response.
Collapse
|
40
|
Yao D, Dai C, Peng S. Mechanism of the mesenchymal-epithelial transition and its relationship with metastatic tumor formation. Mol Cancer Res 2011; 9:1608-20. [PMID: 21840933 DOI: 10.1158/1541-7786.mcr-10-0568] [Citation(s) in RCA: 306] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cancer metastasis consists of a sequential series of events, and the epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET) are recognized as critical events for metastasis of carcinomas. A current area of focus is the histopathological similarity between primary and metastatic tumors, and MET at sites of metastases has been postulated to be part of the process of metastatic tumor formation. Here, we summarize accumulating evidence from experimental studies that directly supports the role of MET in cancer metastasis, and we analyze the main mechanisms that regulate MET or reverse EMT in carcinomas. Given the critical role of MET in metastatic tumor formation, the potential to effectively target the MET process at sites of metastasis offers new hope for inhibiting metastatic tumor formation.
Collapse
Affiliation(s)
- Dianbo Yao
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital of China Medical University, Heping District, Shenyang 110004, Liaoning Province, China
| | | | | |
Collapse
|
41
|
Zhe X, Cher ML, Bonfil RD. Circulating tumor cells: finding the needle in the haystack. Am J Cancer Res 2011; 1:740-751. [PMID: 22016824 PMCID: PMC3195935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/27/2011] [Indexed: 05/31/2023] Open
Abstract
Localized and metastatic cancers give rise to circulating tumor cells (CTCs) which are detectable in the bloodstream. Recent studies have highlighted the prognostic significance of the presence and number of CTCs, particularly in patients with metastatic disease. Future studies are designed not only to detect CTCs, but also to characterize them. This review discusses current and developing methodologies for the isolation and characterization of CTCs as well as recent studies focusing on the clinical relevance of CTC detection and characterization.
Collapse
|
42
|
Bartkowiak K, Riethdorf S, Pantel K. The interrelating dynamics of hypoxic tumor microenvironments and cancer cell phenotypes in cancer metastasis. CANCER MICROENVIRONMENT 2011; 5:59-72. [PMID: 21626313 DOI: 10.1007/s12307-011-0067-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/18/2011] [Indexed: 02/04/2023]
Abstract
The interrelating dynamics of the primary tumor cells and their surrounding microenvironment might determine phenotypic characteristics of disseminated tumor cells and contribute to cancer metastasis. Cytoprotective mechanisms (e.g., energy metabolism control, DNA damage response, global translation control and unfolded protein response) exert selective pressure in the tumor microenvironment. In particular, adaptation to hypoxia is vital for survival of malignant cells in the tumor and at distant sites such as the bone marrow. In addition to the stress response, the ability of tumor cells to undergo certain cellular re-differentiation programmes like the epithelial-mesenchymal transition (EMT), which is linked to cancer stemness, appears to be important for successful cancer cell spread. Here we will discuss the selection pressures that eventually lead to the formation of overt metastases. We will focus the properties of the microenvironment including (i) metabolic and cytoprotective programs that ensure survival of disseminated tumor cells, (ii) blood vessel structure, and (iii) the hypoxia-normoxia switch as well as intrinsic factors affecting the evolvement of novel tumor cell populations.
Collapse
Affiliation(s)
- Kai Bartkowiak
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | | | | |
Collapse
|
43
|
Page K, Hava N, Ward B, Brown J, Guttery DS, Ruangpratheep C, Blighe K, Sharma A, Walker RA, Coombes RC, Shaw JA. Detection of HER2 amplification in circulating free DNA in patients with breast cancer. Br J Cancer 2011; 104:1342-8. [PMID: 21427727 PMCID: PMC3078598 DOI: 10.1038/bjc.2011.89] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2) is amplified and overexpressed in 20-25% of breast cancers. This study investigated circulating free DNA (cfDNA) for detection of HER2 gene amplification in patients with breast cancer. METHODS Circulating free DNA was extracted from plasma of unselected patients with primary breast cancer (22 before surgery and 68 following treatment), 30 metastatic patients and 98 female controls using the QIAamp Blood DNA Mini Kit (Qiagen). The ratio of HER2 to an unamplified reference gene (contactin-associated protein 1 (CNTNAP1)) was measured in cfDNA samples by quantitative PCR (qPCR) using SK-BR-3 cell line DNA as a positive control. RESULTS We validated the qPCR assay with DNA extracted from 23 HER2 3+ and 40 HER2-negative tumour tissue samples; the results agreed for 60 of 63 (95.2%) tumours. Amplification was detected in cfDNA for 8 of 68 patients following primary breast cancer treatment and 5 of 30 metastatic patients, but was undetected in 22 patients with primary breast cancer and 98 healthy female controls. Of the patients with amplification in cfDNA, 10 had HER2 3+ tumour status by immunohistochemistry. CONCLUSIONS The results demonstrate for the first time the existence of amplified HER2 in cfDNA in the follow-up of breast cancer patients who are otherwise disease free. This approach could potentially provide a marker in patients with HER2-positive breast cancer.
Collapse
Affiliation(s)
- K Page
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Building, PO Box 65, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Ren C, Han C, Wang D, Zhao X, Jin G, Shen H. Detection of circulating tumor cells: Clinical relevance of a novel metastatic tumor marker. Exp Ther Med 2011; 2:385-391. [PMID: 22977514 DOI: 10.3892/etm.2011.234] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/08/2011] [Indexed: 12/18/2022] Open
Abstract
Most cancer-related deaths are caused by the hematogenous spread of cancer cells to distant organs and their subsequent metastasis. During the early stages of the metastatic cascade, cancer cells disseminate from the primary site via the lymphatic vessels and/or by hematogenous routes. Circulating tumor cells (CTCs), cancer cells that have disseminated into the systemic circulation, may be a predictor of poor prognosis in several carcinomas. An understanding of the molecular mechanisms involved in the blood-borne dissemination of cancer cells may help to clarify the process of metastasis and provide a powerful and non-invasive approach for anticancer treatments that are tailored to individual patients.
Collapse
Affiliation(s)
- Chuanli Ren
- Clinical Laboratory, Medical College of Yangzhou University, Yangzhou
| | | | | | | | | | | |
Collapse
|
45
|
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.
Collapse
Affiliation(s)
- Holly Graves
- Harrison Department of Surgical Research, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | |
Collapse
|
46
|
Kurkuri MD, Al-Ejeh F, Shi JY, Palms D, Prestidge C, Griesser HJ, Brown MP, Thierry B. Plasma functionalized PDMS microfluidic chips: towards point-of-care capture of circulating tumor cells. ACTA ACUST UNITED AC 2011. [DOI: 10.1039/c1jm10317b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
47
|
Lianidou ES, Markou A. Circulating tumor cells as emerging tumor biomarkers in breast cancer. Clin Chem Lab Med 2011; 49:1579-90. [DOI: 10.1515/cclm.2011.628] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
48
|
Abstract
The increasing number of cancer survivors is cause for celebration, but this expanding population has highlighted the problem of tumour dormancy, which can lead to relapse. As we start to understand more about the biology of dormant cancer cells, we can begin to address how best to treat this form of disease. Preclinical models and initial clinical trials, as exemplified in patients with breast cancer, are paving the way to address how best to treat long-term cancer survivors to minimize the risk of cancer recurrence.
Collapse
Affiliation(s)
- Paul E Goss
- Harvard Medical School, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Lawrence House, RH-302, Boston, Massachusetts 02114, USA
| | | |
Collapse
|
49
|
Mego M, De Giorgi U, Dawood S, Wang X, Valero V, Andreopoulou E, Handy B, Ueno NT, Reuben JM, Cristofanilli M. Characterization of metastatic breast cancer patients with nondetectable circulating tumor cells. Int J Cancer 2010; 129:417-23. [PMID: 20857493 DOI: 10.1002/ijc.25690] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 08/25/2010] [Indexed: 02/06/2023]
Abstract
Circulating tumor cells (CTC) are an independent prognostic factor in metastatic breast cancer patients (MBC). However, CTC are undetectable in one third of patients. The aim of this study was to assess the prognostic factors in MBC patients without detectable CTC. This retrospective study included 292 MBC patients evaluated between January 2004 and December 2007. CTC were enumerated before patients started a new line of treatment using the CellSearch™. Overall survival (OS) was calculated from the date of CTC measurement and estimated by the Kaplan-Meier product limit method. CTC were not detected in 35.96% patients, whereas 40.75% patients had CTC ≥ 5. Undetectable CTC status was positively correlated with presence of brain metastasis (OR: 6.17, 95%CI = 2.14-17.79; p = 0.001), and inversely correlated with bone metastasis (OR: 0.47; 95%CI = 0.27-0.80; p = 0.01). In multivariate analysis, hormone receptors, number of metastatic sites and lines of therapy were independent prognostic factors for OS in patients without detectable CTC. Patients without detectable CTC before starting of a new line of therapy comprise a heterogeneous group with substantially different prognosis. We showed that some important metastatic disease characteristics are predictive of undetectable CTC status in MBC.
Collapse
Affiliation(s)
- Michal Mego
- Departments of Hematopathology, The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Nagaiah G, Abraham J. Circulating tumor cells in the management of breast cancer. Clin Breast Cancer 2010; 10:209-16. [PMID: 20497919 DOI: 10.3816/cbc.2010.n.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most deaths from breast cancer are from metastatic disease. Tests that predict an individual's risk of developing metastatic disease could be useful. There is growing evidence that circulating tumor cells (CTC) could help predict recurrence and effectiveness of therapy. However, there are unresolved issues with CTC detection methods and their implementation in the community. The utility of CTC testing in the management of breast cancer is unclear based on current studies. This article reviews the role of CTC testing in the management of early and metastatic breast cancer.
Collapse
Affiliation(s)
- Govardhanan Nagaiah
- Department of General Internal Medicine and Health Care Research, University Hospitals Case Medical Center, Cleveland, OH, USA
| | | |
Collapse
|