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Menyailo ME, Bokova UA, Ivanyuk EE, Khozyainova AA, Denisov EV. Metastasis Prevention: Focus on Metastatic Circulating Tumor Cells. Mol Diagn Ther 2021; 25:549-562. [PMID: 34287797 DOI: 10.1007/s40291-021-00543-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Abstract
Metastasis is the main cause of cancer death. Metastatic foci are derived from tumor cells that detach from the primary tumor and then enter the circulation. Circulating tumor cells (CTCs) are generally associated with a high probability of distant metastasis and a negative prognosis. Most CTCs die in the bloodstream, and only a few cells form metastases. Such metastatic CTCs have a stem-like and hybrid epithelial-mesenchymal phenotype, can avoid immune surveillance, and show increased therapy resistance. Targeting metastatic CTCs and their progenitors in primary tumors and their descendants, particularly disseminated tumor cells, represents an attractive strategy for metastasis prevention. However, current therapeutic strategies mainly target the primary tumor and only indirectly affect metastasis-initiating cells. Here, we consider potential methods for preventing metastasis based on targeting molecular and cellular features of metastatic CTCs, including CTC clusters. Also, we emphasize current knowledge gaps in CTC biology that should be addressed to develop highly effective therapeutics and strategies for metastasis suppression.
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Affiliation(s)
- Maxim E Menyailo
- Laboratory of Cancer Progression Biology, Cancer Research Institute, Tomsk National Research Medical Center, Kooperativny Str. 5, Tomsk, 634009, Russia
| | - Ustinia A Bokova
- Laboratory of Cancer Progression Biology, Cancer Research Institute, Tomsk National Research Medical Center, Kooperativny Str. 5, Tomsk, 634009, Russia
| | - Elena E Ivanyuk
- Laboratory of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Kooperativny Str. 5, Tomsk, 634009, Russia
| | - Anna A Khozyainova
- Laboratory of Cancer Progression Biology, Cancer Research Institute, Tomsk National Research Medical Center, Kooperativny Str. 5, Tomsk, 634009, Russia
| | - Evgeny V Denisov
- Laboratory of Cancer Progression Biology, Cancer Research Institute, Tomsk National Research Medical Center, Kooperativny Str. 5, Tomsk, 634009, Russia.
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2
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Ebeed SA, Abd El-Moneim NA, Saad A, Zaher ERE, Yassin OG, Khamis SA. Diagnostic and prognostic value of circulating tumor cells in female breast cancer patients. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Samia A. Ebeed
- Medical Research Institute, Radiation Sciences , 165 Elhorreya Avenue, Alexandria, Egypt
| | - Nadia A. Abd El-Moneim
- Medical Research Institute, Radiation Sciences , 165 Elhorreya Avenue, Alexandria, Egypt
| | - Ahmed Saad
- Medical Research Institute, Radiation Sciences , 165 Elhorreya Avenue, Alexandria, Egypt
| | - Ebtsam RE. Zaher
- Medical Research Institute, Radiation Sciences , 165 Elhorreya Avenue, Alexandria, Egypt
| | - Omayma G. Yassin
- Medical Research Institute, Radiation Sciences , 165 Elhorreya Avenue, Alexandria, Egypt
| | - Shadwa A. Khamis
- Medical Research Institute, Radiation Sciences , 165 Elhorreya Avenue, Alexandria, Egypt
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Wu Y, Meng Q, Yang Z, Shi L, Hu R, Zhang P, Wei J, Ren J, Leng B, Xu D, Jiang GQ. Circulating HER-2 mRNA in the peripheral blood as a potential diagnostic and prognostic biomarker in females with breast cancer. Oncol Lett 2018; 16:3726-3734. [PMID: 30127983 PMCID: PMC6096115 DOI: 10.3892/ol.2018.9091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/04/2018] [Indexed: 01/04/2023] Open
Abstract
Breast cancer is a prevalent malignant cancer worldwide, and a lack of defined biomarkers for early prognostication contributes to its high associated mortality rate, especially in human epidermal growth factor receptor 2 (HER-2)-positive breast cancer. In the present study, HER-2 mRNA levels in patients were detected prior to surgery and during neoadjuvant chemotherapy to explore its potential diagnostic and prognostic value. Blood samples were collected from 70 patients with breast cancer, including 50 HER-2-negative and 20 HER-2-positive patients, prior to and following surgery (postoperative, n=13; neoadjuvant chemotherapy, n=5); the control group included 35 samples from healthy individuals. The relative mRNA level of HER-2 in blood was determined by one-step reverse transcription-quantitative polymerase chain reaction. HER-2 expression curves of measurements taken during neoadjuvant chemotherapy were compared with the tumor size. A significant difference in the blood HER-2 mRNA level was observed between healthy women and patients with breast cancer (P<0.0001). A cutoff value of 1.512 was established for the circulating HER-2 level in healthy subjects based on the upper 95% confidence interval value of samples from the control group. The level of HER-2 mRNA in blood was associated with the HER-2 status, Ki-67 expression, and lymphovascular invasion in primary tumor tissue samples; however, there was no association with the lymph node status, tumor stage, tumor grade, tumor size, patient age, estrogen or progesterone receptor status of the primary tumor. HER-2 mRNA levels were associated with the response rate, as determined by primary tumor size, in patients who received neoadjuvant chemotherapy. In conclusion, baseline and early changes in peripheral blood HER-2 mRNA indicated that HER-2 mRNA may be a potential diagnostic biomarker for breast cancer and a prognostic marker for predicting the efficacy of neoadjuvant therapy.
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Affiliation(s)
- Yanlin Wu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Qiping Meng
- GenePharma Limited Liability Company, Suzhou, Jiangsu 215125, P.R. China
| | - Zhixue Yang
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Lili Shi
- GenePharma Limited Liability Company, Suzhou, Jiangsu 215125, P.R. China
| | - Rongkuan Hu
- GenePharma Limited Liability Company, Suzhou, Jiangsu 215125, P.R. China
| | - Peizhuo Zhang
- GenePharma Limited Liability Company, Suzhou, Jiangsu 215125, P.R. China
| | - Jinrong Wei
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Jie Ren
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Bingjing Leng
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Dong Xu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Guo-Qin Jiang
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
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Nunes RA, Li X, Kang SP, Burstein H, Roberts L, Carney W, Blackwell K, Ryan P, Borges V, Iglehart JD, Friedman P, Harris LN. Circulating Tumor Cells in HER-2 Positive Metastatic Breast Cancer Patients Treated with Trastuzumab and Chemotherapy. Int J Biol Markers 2018; 24:1-10. [DOI: 10.1177/172460080902400101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The detection of circulating tumor cells (CTCs) in peripheral blood may have important prognostic and predictive implications in breast cancer treatment. A limitation in this field has been the lack of a validated method of accurately measuring CTCs. While sensitivity has improved using RT-PCR, specificity remains a major challenge. The goal of this paper is to present a sensitive and specific methodology of detecting CTCs in women with HER-2-positive metastatic breast cancer, and to examine its role as a marker that tracks disease response during treatment with trastuzumab-containing regimens. The study included patients with HER-2-positive metastatic breast cancer enrolled on two different clinical protocols using a trastuzumab-containing regimen. Serial CTCs were measured at planned time points and clinical correlations were made. Immunomagnetic selection of circulating epithelial cells was used to address the specificity of tumor cell detection using cytokeratin 19 (CK19). In addition, the extracellular domain of the HER-2 protein (HER-2/ECD) was measured to determine if CTCs detected by CK19 accurately reflect tumor burden. The presence of CTCs at first restaging was associated with disease progression. We observed an association between CK19 and HER-2/ECD. The association of HER-2/ECD with clinical response followed a similar pattern to that seen with CK19. Finally, the absence of HER-2/ECD at best overall response and a change of HER-2/ECD from positive at baseline to negative at best overall response was associated with favorable treatment response. Our study supports the prognostic and predictive role of the detection of CTCs in treatment of HER-2-positive metastatic breast cancer patients. The association between CK19 and markers of disease burden is in line with the concept that CTCs may be a reliable measure of tumor cells in the peripheral blood of patients with metastatic breast cancer. The association of CTCs at first restaging with treatment failure indicates that CTCs may have a role as surrogate markers to monitor treatment response.
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Affiliation(s)
- Raquel A. Nunes
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xiaochun Li
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Soonmo Peter Kang
- Section of Medical Oncology, Yale University School of Medicine/Yale Cancer Center, New Haven, CT - USA
| | - Harold Burstein
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Walter Carney
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kimberly Blackwell
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Paula Ryan
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Virginia Borges
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - J. Dirk Iglehart
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Lyndsay N. Harris
- Section of Medical Oncology, Yale University School of Medicine/Yale Cancer Center, New Haven, CT - USA
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5
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Wang CH, Chang CJ, Yeh KY, Chang PH, Huang JS. The Prognostic Value of HER2-Positive Circulating Tumor Cells in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Clin Breast Cancer 2017; 17:341-349. [DOI: 10.1016/j.clbc.2017.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 12/18/2022]
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6
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Appierto V, Di Cosimo S, Reduzzi C, Pala V, Cappelletti V, Daidone MG. How to study and overcome tumor heterogeneity with circulating biomarkers: The breast cancer case. Semin Cancer Biol 2017; 44:106-116. [PMID: 28442298 DOI: 10.1016/j.semcancer.2017.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022]
Abstract
Breast cancer ranks first among female cancer-related deaths in Western countries. As the primary tumor can often be controlled by surgical resection, the survival of women with breast cancer is closely linked to the incidence of distant metastases. Molecular screening by next generation sequencing highlighted the spatial and temporal heterogeneity of solid tumors as well as the clonal evolution of cancer cells during progression and under treatment pressure. Such findings question whether an optimal assessment of disease progression and a screening for druggable mutations should be based on molecular features of primary or recurrent/metastatic lesions and therefore represent a crucial element for failure or success of personalized medicine. In fact, new targeted therapies may induce only short-term benefit annulled by the emergence of resistant clones with new driver mutations which would need to be rapidly and reliably identified. Serial tissue sampling is therefore essential but, unfortunately, also represents a problem since biopsies from solid lesions, which are invasive and potentially painful and risky, cannot be easily repeatedly sampled, are inaccessible or may not fully reflect tumor heterogeneity. The need to early detect and strike this "moving target" is now directing the scientific community toward liquid biopsy-based biomarkers, which include circulating tumor cells (CTC) and cell-free circulating tumor DNA (ctDNA), can be repeatedly assessed through non-invasive and easy-to-perform procedures and may act as reliable read-outs of functional and molecular features of recurrent/metastatic lesions. In this review we summarize the outcome of CTCs and ctDNA in breast cancer, with special reference on their role on unveiling and overcoming tumor heterogeneity, on their potential relevance for tumor surveillance and monitoring, and for the selection of therapeutic options. Finally, we propose integration between blood-based molecular and clinical approaches for monitoring disease progression according to the specific pattern of recurrence of the most aggressive breast cancer molecular subtypes.
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Affiliation(s)
- Valentina Appierto
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.A. Amadeo, 42, 20133 Milan, Italy.
| | - Serena Di Cosimo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.A. Amadeo, 42, 20133 Milan, Italy.
| | - Carolina Reduzzi
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.A. Amadeo, 42, 20133 Milan, Italy.
| | - Valentina Pala
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.A. Amadeo, 42, 20133 Milan, Italy.
| | - Vera Cappelletti
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.A. Amadeo, 42, 20133 Milan, Italy.
| | - Maria Grazia Daidone
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.A. Amadeo, 42, 20133 Milan, Italy.
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7
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Luz MCDB, Perez MM, Azzalis LA, Sousa LVDA, Adami F, Fonseca FLA, Alves BDCA. Evaluation of MCT1, MCT4 and CD147 Genes in Peripheral Blood Cells of Breast Cancer Patients and Their Potential Use as Diagnostic and Prognostic Markers. Int J Mol Sci 2017; 18:ijms18040170. [PMID: 28333070 PMCID: PMC5412261 DOI: 10.3390/ijms18040170] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/26/2016] [Accepted: 01/08/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Patients with breast cancer—the deadliest cancer among women—are at constant risk of developing metastasis. Oxidative stress and hypoxia are common feature of tumor cells that can proliferate even in a resultant metabolic acidosis. Despite the low extracellular pH, intracellular pH of tumor cells remains relatively normal, or even more alkaline due to the action of a membrane protein family known as monocarboxylate transporters (MCTs). The objective of this study was to verify the diagnostic and prognostic value of MCT1, MCT4 and CD147 in tumor and peripheral blood samples of patients with breast cancer undergoing chemotherapic treatment. Methods: Differential expression of MCT1, MCT4 and CD147 obtained by qPCR was determined by 2−ΔΔCq method between biological samples (tumor and serial samples of peripheral) of patients (n = 125) and healthy women (n = 25). Results: tumor samples with higher histological grades have shown higher expression of these markers; this higher expression was also observed in blood samples obtained at diagnosis of patients when compared to healthy women and in patients with positive progression of the disease (metastasis development). Conclusion: markers studied here could be a promising strategy in routine laboratory evaluations as breast cancer diagnosis and prognosis.
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Affiliation(s)
- Maria Cláudia de B Luz
- Clinical Laboratory, Faculdade de Medicina do ABC (FMABC), Av. Príncipe de Gales, 821, CEP 09060-650 Santo André, SP, Brazil.
| | - Matheus M Perez
- Clinical Laboratory, Faculdade de Medicina do ABC (FMABC), Av. Príncipe de Gales, 821, CEP 09060-650 Santo André, SP, Brazil.
| | - Ligia A Azzalis
- Biological Science Department, UNIFESP, Rua Prof. Artur Riedel, 275, CEP 09972-270 Diadema, SP, Brazil.
| | - Luiz Vinícius de A Sousa
- Epidemiology Laboratory and Data Analysis, FMABC, Av. Príncipe de Gales, 821, CEP 09060-650 Santo André, SP, Brazil.
| | - Fernando Adami
- Epidemiology Laboratory and Data Analysis, FMABC, Av. Príncipe de Gales, 821, CEP 09060-650 Santo André, SP, Brazil.
| | - Fernando L A Fonseca
- Clinical Laboratory, Faculdade de Medicina do ABC (FMABC), Av. Príncipe de Gales, 821, CEP 09060-650 Santo André, SP, Brazil.
- Biological Science Department, UNIFESP, Rua Prof. Artur Riedel, 275, CEP 09972-270 Diadema, SP, Brazil.
| | - Beatriz da C A Alves
- Clinical Laboratory, Faculdade de Medicina do ABC (FMABC), Av. Príncipe de Gales, 821, CEP 09060-650 Santo André, SP, Brazil.
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Tachtsidis A, McInnes LM, Jacobsen N, Thompson EW, Saunders CM. Minimal residual disease in breast cancer: an overview of circulating and disseminated tumour cells. Clin Exp Metastasis 2016; 33:521-50. [PMID: 27189371 PMCID: PMC4947105 DOI: 10.1007/s10585-016-9796-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/22/2016] [Indexed: 12/11/2022]
Abstract
Within the field of cancer research, focus on the study of minimal residual disease (MRD) in the context of carcinoma has grown exponentially over the past several years. MRD encompasses circulating tumour cells (CTCs)—cancer cells on the move via the circulatory or lymphatic system, disseminated tumour cells (DTCs)—cancer cells which have escaped into a distant site (most studies have focused on bone marrow), and resistant cancer cells surviving therapy—be they local or distant, all of which may ultimately give rise to local relapse or overt metastasis. Initial studies simply recorded the presence and number of CTCs and DTCs; however recent advances are allowing assessment of the relationship between their persistence, patient prognosis and the biological properties of MRD, leading to a better understanding of the metastatic process. Technological developments for the isolation and analysis of circulating and disseminated tumour cells continue to emerge, creating new opportunities to monitor disease progression and perhaps alter disease outcome. This review outlines our knowledge to date on both measurement and categorisation of MRD in the form of CTCs and DTCs with respect to how this relates to cancer outcomes, and the hurdles and future of research into both CTCs and DTCs.
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Affiliation(s)
- A Tachtsidis
- St. Vincent's Institute, Melbourne, VIC, Australia
- University of Melbourne, Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - L M McInnes
- School of Surgery, The University of Western Australia, Perth, WA, Australia
| | - N Jacobsen
- School of Surgery, The University of Western Australia, Perth, WA, Australia
| | - E W Thompson
- University of Melbourne, Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Translational Research Institute, Woolloongabba, QLD, Australia
| | - C M Saunders
- School of Surgery, The University of Western Australia, Perth, WA, Australia.
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9
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Kuniyoshi RK, Gehrke FDS, Alves BCA, Vilas-Bôas V, Coló AE, Sousa N, Nunes J, Fonseca FLA, Del Giglio A. Gene profiling and circulating tumor cells as biomarker to prognostic of patients with locoregional breast cancer. Tumour Biol 2015; 36:8075-83. [PMID: 25976504 DOI: 10.1007/s13277-015-3529-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/04/2015] [Indexed: 01/03/2023] Open
Abstract
The gene profile of primary tumors, as well as the identification of circulating tumor cells (CTCs), can provide important prognostic and predictive information. In this study, our objective was to perform tumor gene profiling (TGP) in combination with CTC characterization in women with nonmetastatic breast cancer. Biological samples (from peripheral blood and tumors) from 167 patients diagnosed with stage I, II, and III mammary carcinoma, who were also referred for adjuvant/neoadjuvant chemotherapy, were assessed for the following parameters: (a) the presence of CTCs identified by the expression of CK-19 and c-erbB-2 in the peripheral blood mononuclear cell (PBMC) fraction by quantitative reverse transcription PCR (RT-PCR) and (b) the TGP, which was determined by analyzing the expression of 21 genes in paraffin-embedded tissue samples by quantitative multiplex RT-PCR with the Plexor® system. We observed a statistically significant correlation between the progression-free interval (PFI) and the clinical stage (p = 0.000701), the TGP score (p = 0.006538), and the presence of hormone receptors in the tumor (p = 0.0432). We observed no correlation between the PFI and the presence or absence of CK-19 or HER2 expression in the PBMC fraction prior to the start of treatment or in the two following readouts. Multivariate analysis revealed that only the TGP score significantly correlated with the PFI (p = 0.029247). The TGP is an important prognostic variable for patients with locoregional breast cancer. The presence of CTCs adds no prognostic value to the information already provided by the TGP.
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Affiliation(s)
- Renata K Kuniyoshi
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Flávia de Sousa Gehrke
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Beatriz C A Alves
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Viviane Vilas-Bôas
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Anna E Coló
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Naiara Sousa
- Fundação Pio XII-Hospital de Câncer de Barretos, R. Antenor Duarte Vilela, 1331, Barretos, SP, Brazil.
| | - João Nunes
- Fundação Pio XII-Hospital de Câncer de Barretos, R. Antenor Duarte Vilela, 1331, Barretos, SP, Brazil.
| | - Fernando L A Fonseca
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
- Biological Sciences Department, Federal University of São Paulo, R. Prof. Arthur Riedel, 275, CEP 09972-270, Diadema, SP, Brazil.
| | - Auro Del Giglio
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
- , Rua Mariana Correia 369, 01444-000, São Paulo, Capital, Brazil.
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10
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Hall C, Karhade M, Laubacher B, Anderson A, Kuerer H, DeSynder S, Lucci A. Circulating Tumor Cells After Neoadjuvant Chemotherapy in Stage I-III Triple-Negative Breast Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S552-8. [PMID: 25968619 DOI: 10.1245/s10434-015-4600-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is characterized by a lack of estrogen and progesterone receptor expression and HER-2 gene amplification. Circulating tumor cells (CTCs) can be identified in 25 % of nonmetastatic breast cancer patients, and the identification of ≥1 CTC predicts outcome. This study was designed to determine whether CTCs present after neoadjuvant chemotherapy (NACT) predicted worse outcome in nonmetastatic TNBC patients. METHODS CTCs were assessed in 57 TNBC patients with nonmetastatic TNBC after the completion of NACT. CTCs (per 7.5 ml blood) were identified using the Cell Search(®) System (Janssen). Log-rank test and Cox regression analysis were applied to establish the association of CTCs with relapse-free (RFS) and overall survival (OS). RESULTS Median follow-up was 30 months, and mean age was 53 years. Fifty-four patients (95 %) had >2-cm tumors, 42 (84 %) were nuclear grade 3, and 42 (74 %) had positive axillary lymph nodes. One or more CTC was identified in 30 % of patients. CTC presence was not associated with primary tumor size, high grade, or lymph node positivity. Multivariate analysis demonstrated that detection of ≥1 CTC predicted decreased RFS (log-rank P = 0.03, HR 5.25, 95 % CI 1.34-20.56) and OS (log-rank P = 0.03, HR 7.04, 95 % CI 1.26-39.35). CONCLUSIONS One or more CTCs present after NACT predicted relapse and survival in nonmetastatic TNBC patients. This information would be helpful in future clinical trial design of adjuvant treatments for TNBC patients who are at risk for relapse after completing NACT.
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Affiliation(s)
- Carolyn Hall
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mandar Karhade
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Laubacher
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amber Anderson
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry Kuerer
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah DeSynder
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Karhade M, Hall C, Mishra P, Anderson A, Kuerer H, Bedrosian I, Krishnamurthy S, Lucci A. Circulating tumor cells in non-metastatic triple-negative breast cancer. Breast Cancer Res Treat 2014; 147:325-33. [PMID: 25164970 PMCID: PMC4149877 DOI: 10.1007/s10549-014-3103-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
Abstract
Circulating tumor cells (CTCs) can be identified in approximately 25 % of stage I-III breast cancer patients; CTCs presence is a predictor of poor outcome in metastatic breast cancer, but little is known regarding the prognostic significance of CTCs in non-metastatic triple-negative breast cancer (TNBC) patients. The aim of this study was to determine whether CTCs predict worse outcome in non-metastatic TNBC patients. We evaluated CTCs in 113 patients with stages I-III TNBC at the time of definitive surgery. CTCs were assessed using the CellSearch System®. Progression-free and overall survival were defined as time elapsed between date of diagnosis and either date of clinical disease progression, death, or last follow-up. Log-rank test and Cox regression analysis were used to determine associations of CTCs with progression-free and overall survival. The median follow-up was 40 months. CTCs were identified in 23/113 (20 %) of patients. No primary tumor characteristic or lymph node status predicted the presence of CTCs. The identification of ≥2 CTCs predicted shorter progression-free (log rank P ≤ 0.001; hazard ratio 8.30, 95 % CI 2.61–26.37) and overall survival (log rank P = 0.0004; hazard ratio 7.19, 95 % CI 1.98–26.06) versus survival for patients with <2 CTCs. Two or more CTCs predict shorter progression-free and overall survival in TNBC patients. Larger studies are needed to determine whether CTC assessment provides beneficial information that could be used in stratifying TNBC patients at increased risk for disease progression. Finally, CTCs characterization could facilitate the development of novel treatment approaches for TNBC.
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Affiliation(s)
- Mandar Karhade
- Department of Surgical Oncology, Unit 0444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Mikulová V, Čabiňaková M, Janatková I, Mestek O, Zima T, Tesařová P. Detection of circulating tumor cells during follow-up of patients with early breast cancer: Clinical utility for monitoring of therapy efficacy. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 74:132-42. [DOI: 10.3109/00365513.2013.864784] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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Onstenk W, Gratama J, Foekens J, Sleijfer S. Towards a personalized breast cancer treatment approach guided by circulating tumor cell (CTC) characteristics. Cancer Treat Rev 2013; 39:691-700. [DOI: 10.1016/j.ctrv.2013.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 01/16/2023]
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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.
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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
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Hall C, Laubacher B, Lucci A. Detection and prognostic significance of circulating tumor cells in nonmetastatic breast cancer patients. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Distant metastasis remains the primary cause of death for breast cancer patients. Metastasis is a complex, multistep process wherein a subset of cells from a heterogeneous tumor acquire the ability to disseminate from the primary tumor and invade the blood and/or lymph nodes. Although tumor size, tumor characteristics and axillary lymph node status are the most common parameters utilized to predict disease recurrence in nonmetastatic patients, a significant number of lymph node-negative patients with localized disease will develop distant metastases despite successful primary treatment. These data suggest that tumor cell dissemination can occur early in disease progression, sometimes bypassing the lymphatic system. Occult micrometastases, or circulating tumor cells in the blood, are rare tumor cells that remain undetected by standard histopathogical and high-resolution imaging methodologies. This review focuses on current methodologies used to detect circulating tumor cells and their prognostic significance in nonmetastatic breast cancer patients.
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Affiliation(s)
- Carolyn Hall
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, 1515 Blvd, Houston, TX 77030, USA
| | - Barbara Laubacher
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, 1515 Blvd, Houston, TX 77030, USA
| | - Anthony Lucci
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, 1515 Blvd, Houston, TX 77030, USA
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The HER2 status of disseminated tumor cells in the bone marrow of early breast cancer patients is independent from primary tumor and predicts higher risk of relapse. Breast Cancer Res Treat 2013; 138:509-17. [PMID: 23494674 DOI: 10.1007/s10549-013-2470-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/26/2013] [Indexed: 02/03/2023]
Abstract
Overexpression of the HER2-receptor in early breast cancer (EBC) patients is associated with aggressive tumor behavior. However, women suffering from HER2-positive EBC benefit from trastuzumab treatment. As the HER2 status of the primary tumor may differ from that of disseminated tumor cells (DTC) in bone marrow (BM), the aim of this study was (1) to compare the HER2 status of the primary tumor (prim-HER2-status) with that of DTC (DTC-HER2-status) and (2) to analyze the influence of the DTC-HER2-status on patient survival. For this purpose, BM aspirates from 569 EBC patients were analyzed for the presence of DTC. The DTC-HER2-status was identified by a double-staining procedure against cytokeratin and the HER2-receptor. DTC were detected in 151 (27 %) patients. The concordance between the HER2 status of DTC and the primary tumor was 51 %. In patients with detectable DTC, mean disease-free survival was 77.44 (95 % CI 74.72-80.17) months for DTC-HER2-negative and 55.15 (95 % CI 48.57-61.79) months for DTC-HER2-positive patients (p = 0.044). The multivariate analysis showed that the DTC-HER2-status was an independent predictor of disease-free survival. In conclusion, the presence of HER2-positive DTC in EBC patients is associated with an increased risk of relapse. Due to the low concordance between the HER2 status of the primary tumor and DTC, only a minority (13 %) of the DTC-HER2-positive patients was treated with trastuzumab. These patients might, however, benefit from HER2-directed therapy.
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Krishnamurthy S, Bischoff F, Ann Mayer J, Wong K, Pham T, Kuerer H, Lodhi A, Bhattacharyya A, Hall C, Lucci A. Discordance in HER2 gene amplification in circulating and disseminated tumor cells in patients with operable breast cancer. Cancer Med 2013; 2:226-33. [PMID: 23634290 PMCID: PMC3639661 DOI: 10.1002/cam4.70] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 12/12/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) gene amplification in circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) might be useful for modifying Herceptin therapy in breast cancer. In the process of investigating the utility of a microfluidic platform for detecting HER2 gene amplification in these cells, we observed novel results on discordance of HER2 status. Peripheral blood (8.5 mL) and bone marrow (BM) (7.5-10 mL) were collected prospectively from patients with clinical stages I-IV breast cancer. Mononuclear cells were recovered, stained with cytokeratin (CK), CD45, and DAPI, and processed through microfluidic channels for fluorescence in situ hybridization (FISH). A ratio of HER2:CEP17 >2 in any CK+/CD45 or CK-/CD45 cell was regarded as positive for HER2 gene amplification. Peripheral blood from 95 patients and BM from 78 patients were studied. We found CK+/CD45-/DAPI+ CTCs in 27.3% of patients. We evaluated HER2 gene amplification by FISH in 88 blood and 78 BM specimens and found HER2+ CTCs in 1 of 9 (11.1%) and HER2+ DTCs (27.2%) in 3 of 11 patients with HER2+ primary tumor. Among patients with a HER2- primary tumor, 5 of 79 had HER2+ CTCs (6.3%) and 14 of 67 had HER2+ DTCs (20.8%). The overall rate of discordance in HER2 status was 15% between primary tumor and CTCs and 28.2% between primary tumor and DTCs. HER2 was amplified in CTCs and DTCs in a portion of both HER2+ and HER2- primary tumors. HER2 discordance was more frequent for DTCs. The clinical implications of evaluating HER2 status in CTCs and DTCs in breast cancer needs to be established in prospective clinical trials. The cell enrichment and extraction microfluidic technology provides a sensitive platform for evaluation of HER2 gene amplification in CTCs and DTCs.
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Affiliation(s)
- Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, Texas 77030, USA.
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Abstract
The detection of circulating tumor cells (CTC) aids in diagnosis of disease, prognosis, disease recurrence, and therapeutic response. The molecular aspects of metastasis are reviewed including its relevance in the identification and characterization of putative markers that may be useful in the detection thereof. Also discussed are methods for CTC enrichment using molecular strategies. The clinical application of CTC in the metastatic disease process is also summarized.
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Aurilio G, Sciandivasci A, Munzone E, Sandri MT, Zorzino L, Cassatella MC, Verri E, Rocca MC, Nolè F. Prognostic value of circulating tumor cells in primary and metastatic breast cancer. Expert Rev Anticancer Ther 2012; 12:203-14. [PMID: 22316368 DOI: 10.1586/era.11.208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with breast cancer, there is evidence correlating the presence of circulating tumor cells (CTCs) with disease-free survival, progression-free survival and overall survival. The detection of CTCs may be useful in gaining a better understanding of the mechanisms of tumor growth and in the improvement of patient management. This review analyzes the prognostic and predictive relevance of CTCs through the principal published studies, cytometric techniques and nucleic acid-based approaches to detect CTCs, phenotypic expression of specific receptors, molecular pathways and genetic signatures for potential tailored therapies.
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Affiliation(s)
- Gaetano Aurilio
- European Institute of Oncology, Medical Care Unit, Department of Medical Oncology, Ripamonti Street 435, Milan 20141, Italy.
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Kulkarni S, Augoff K, Rivera L, McCue B, Khoury T, Groman A, Zhang L, Tian L, Sossey-Alaoui K. Increased expression levels of WAVE3 are associated with the progression and metastasis of triple negative breast cancer. PLoS One 2012; 7:e42895. [PMID: 22952619 PMCID: PMC3428347 DOI: 10.1371/journal.pone.0042895] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 07/13/2012] [Indexed: 12/15/2022] Open
Abstract
Background Breast Cancer (BC) is a heterogeneous disease comprised of at least five genetically distinct subtypes, which together form the second leading cause of cancer death in women in the United States. Within BC subtypes, those classified as Triple Negative BCs (TNBCs) exhibit dismal survival rates due to their propensity to develop distant metastases. We have identified the WAVE3 protein, which is a critical regulator of actin cytoskeleton dynamics that are required for the motility and invasion of cancer cells through its activation of the Arp2/3 complex, as a key regulator of the different steps of the invasion-metastasis cascade in BC, especially in the more aggressive TNBCs. Our published studies have also shown that elevated expression levels of WAVE3 in the TNBC cell lines directly contribute to their increased invasion and metastasis potentials both in vitro and in vivo in murine models of BC metastasis. Methodology/Principal Findings Herein, we utilized both immunohistochemistry (IHC) of primary human BC tumors as well as quantitative real-time RT-PCR of WAVE3 in the peripheral blood of BC patients to clearly establish that WAVE3 is a predictive marker of overall BC patients’ survival. High levels of WAVE3 were predictive for reduced distant recurrence-free survival as well as for decreased disease-specific mortality. Our analysis of WAVE3 expression levels in the peripheral blood of BC patients showed that WAVE3 is highly expressed in the blood of patients who developed metastatic breast cancer compared to those who did not. WAVE3 expression was also highly upregulated in the blood of BC patients with the more aggressive TNBC subtype. Conclusions Together, these findings establish WAVE3 as a novel marker for increased risk of breast-cancer-specific mortality and for the metastatic potential of the TNBCs, and also identify WAVE3 as an attractive therapeutic target for the treatment of metastatic BC.
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Affiliation(s)
- Swati Kulkarni
- Department of Surgery, The University of Chicago Medical Center, Chicago, Illinois, United States of America
- * E-mail: (SK); (KSA)
| | - Katarzyna Augoff
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Louis Rivera
- Department of Surgery, Naval Medical Center San Diego, San Diego, California, United States of America
| | - Brian McCue
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Li Zhang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Lili Tian
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Khalid Sossey-Alaoui
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail: (SK); (KSA)
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Zhang L, Riethdorf S, Wu G, Wang T, Yang K, Peng G, Liu J, Pantel K. Meta-analysis of the prognostic value of circulating tumor cells in breast cancer. Clin Cancer Res 2012; 18:5701-10. [PMID: 22908097 DOI: 10.1158/1078-0432.ccr-12-1587] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The prognostic value of circulating tumor cells (CTC) detected in breast cancer patients is currently under debate. Different time points of blood collections and various CTC assays have been used in the past decades. Here, we conducted the first comprehensive meta-analysis of published literature on the prognostic relevance of CTC, including patients with early and advanced disease. EXPERIMENTAL DESIGN A comprehensive search for articles published between January 1990 and January 2012 was conducted; reviews of each study were conducted and data were extracted. The main outcomes analyzed were overall survival (OS) and disease-free survival (DFS) in early-stage breast cancer patients, as well as progression-free survival (PFS) and OS in metastatic breast cancer patients. Pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using the random and the fixed-effects models. Subgroup and sensitivity analyses were also conducted. RESULTS Forty-nine eligible studies enrolling 6,825 patients were identified. The presence of CTC was significantly associated with shorter survival in the total population. The prognostic value of CTC was significant in both early (DFS: HR, 2.86; 95% CI, 2.19-3.75; OS: HR, 2.78; 95% CI, 2.22-3.48) and metastatic breast cancer (PFS: HR, 1.78; 95% CI, 1.52-2.09; OS: HR, 2.33; 95% CI, 2.09-2.60). Further subgroup analyses showed that our results were stable irrespective of the CTC detection method and time point of blood withdrawal. CONCLUSION Our present meta-analysis indicates that the detection of CTC is a stable prognosticator in patients with early-stage and metastatic breast cancer. Further studies are required to explore the clinical utility of CTC in breast cancer.
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Affiliation(s)
- Liling Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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22
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Chong MH, Zhao Y, Wang J, Zha XM, Liu XA, Ling LJ, Du Q, Wang S. The dynamic change of circulating tumour cells in patients with operable breast cancer before and after chemotherapy based on a multimarker QPCR platform. Br J Cancer 2012; 106:1605-10. [PMID: 22516945 PMCID: PMC3349184 DOI: 10.1038/bjc.2012.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: The possible presence of early tumour dissemination is the rationale behind the use of systemic adjuvant chemotherapy in patients with operable breast cancer. Circulating tumour cells (CTC) in peripheral blood may represent the possible presence of early tumour dissemination. However, relatively few studies were designed to investigate the relationship between the change of CTC status and the efficacy of adjuvant chemotherapy in operable breast cancer patients. Methods: In a prospective study, we established a multimarker real-time quantitative PCR platform to detect CTC in peripheral blood of breast cancer patients. By using this platform, we detected CTC in peripheral blood of 94 operable breast cancer patients. Control group consisted of 20 patients with benign breast disease and 20 healthy volunteers. For 72 patients who underwent systemic adjuvant chemotherapy, the dynamic CTC status at three different time points (1 day before initiation of chemotherapy, 1 week after three cycles of chemotherapy and 1 week after all cycles of chemotherapy) was observed. Results: Circulating tumour cells were detected in 56% (53 out of 94) of patients with operable breast cancer. The specificity was 95%. Seventy-two patients who received systemic adjuvant chemotherapy were followed up. After three cycles of chemotherapy, 47% (18 out of 38) of patients who were CTC-positive before chemotherapy changed into negative status. In addition, another 5% (2 out of 38) of patients had changed into negative status after all cycles of chemotherapy. Conclusion: Systemic adjuvant chemotherapy had a significant impact on CTC status, and this effect could be observed after three cycles of chemotherapy. Circulating tumour cells detection had the potential to be used to evaluate the efficacy of systemic adjuvant chemotherapy immediately after the chemotherapy was finished in operable breast cancer patients.
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Affiliation(s)
- M-h Chong
- Department of Breast Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
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Georgoulias V, Bozionelou V, Agelaki S, Perraki M, Apostolaki S, Kallergi G, Kalbakis K, Xyrafas A, Mavroudis D. Trastuzumab decreases the incidence of clinical relapses in patients with early breast cancer presenting chemotherapy-resistant CK-19mRNA-positive circulating tumor cells: results of a randomized phase II study. Ann Oncol 2012; 23:1744-50. [PMID: 22377561 DOI: 10.1093/annonc/mds020] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the detection of circulating tumor cells (CTCs) which express HER2 is an adverse prognostic factor in early breast cancer patients, we investigated the effect of trastuzumab on patients' clinical outcome. PATIENTS AND METHODS Seventy five women with HER2 (-) breast cancer and detectable CK19 mRNA-positive CTCs before and after adjuvant chemotherapy, were randomized to receive either trastuzumab (n=36) or observation (n=39). CK19 mRNA-positive CTCs were detected by RT-PCR and double stained CK(+)/HER2(+) cells by immunofluorescence. The primary endpoint was the 3-year disease-free survival rate. RESULTS Fifty-one (89%) of the 57 analyzed patients had HER2-expressing CTCs. After trastuzumab administration, 27 of 36 (75%) women became CK19 mRNA-negative compared to seven of 39 (17.9%) in the observation arm (p=0.001). After a median follow up time of 67.2 months, four (11%) and 15 (38%) relapses were observed in the trastuzumab and observation arm, respectively (p=0.008); subgroup analysis indicated that this effect was mainly confined to women with >3 involved axillary lymph nodes (p=0.004). The median DFS was also significantly higher for the trastuzumab-treated patients (p=0.008). CONCLUSION Administration of trastuzumab can eliminate chemotherapy-resistant CK19 mRNA-positive CTCs, reduce the risk of disease recurrence and prolong the DFS.
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Affiliation(s)
- V Georgoulias
- Department of Medical Oncology, University Hospital of Heraklion, and Medical School, University of Crete, Heraklion, Crete, Greece.
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de Albuquerque A, Kaul S, Breier G, Krabisch P, Fersis N. Multimarker Analysis of Circulating Tumor Cells in Peripheral Blood of Metastatic Breast Cancer Patients: A Step Forward in Personalized Medicine. ACTA ACUST UNITED AC 2012; 7:7-12. [PMID: 22553466 DOI: 10.1159/000336548] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM: To develop an immunomagnetic assay for the isolation of circulating tumor cells (CTCs) followed by the analysis of a multimarker panel, which will enable the characterization of these malignant cells with high accuracy. PATIENTS AND METHODS: Peripheral blood (PB) was collected from 32 metastatic breast cancer patients and 42 negative controls. The antibodies BM7 and VU1D9 were used for immunomagnetic tumor cell enrichment. A real-time reverse transcription-polymerase chain reaction (RT-PCR) approach for the markers KRT19, SCGB2A2, MUC1, EPCAM, BIRC5 and ERBB2 was used for CTC detection and characterization. RESULTS: THE POSITIVITY RATES FOR EACH MARKER WERE AS FOLLOWS: 46.9% for KRT19, 25.0% for SCGB2A2, 28.1% for MUC1, 28.1% for EPCAM, 21.9% for BIRC5, and 15.6% for ERBB2. After the creation of individualized cutoffs, the sensitivity and specificity of the combined marker gene panel increased to 56.3% and 100%, respectively. Interestingly, 27.0% of the HER2-negative tumor patients showed ERBB2 mRNA-positive CTCs. CONCLUSIONS: The described technique can be used to measure CTCs with great accuracy. The use of a multimarker panel for the characterization of CTCs may provide real-time information and be of great value in therapy monitoring.
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Affiliation(s)
- Andreia de Albuquerque
- Department of Pathology, Faculty of Medicine Carl Gustav Carus, University of Dresden, Klinikum Chemnitz, Germany
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Abstract
The presence of circulating tumor cells (CTCs) in the blood as well as disseminated tumor cells (DTCs) in the bone marrow of breast cancer patients is associated with a worsened prognosis in the primary as well as in the metastatic situation. Next to their detection, evaluation of human epidermal growth factor receptor (HER2) expression is a valuable feature of CTCs/DTCs. As the HER2 status may change during disease progression CTCs/DTCs might (1) characterize the phenotype of minimal residual disease in the adjuvant setting and (2) serve as a "real time biopsy" of metastatic breast cancer. Phenotyping of CTCs/DTCs will thus help to understand mechanism of resistance to HER2-directed therapy. Moreover, patients that are likely to benefit from HER2-directed therapy despite a HER2-negative primary tumor might be identified.
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Lianidou ES, Markou A. Molecular assays for the detection and characterization of CTCs. Recent Results Cancer Res 2012; 195:111-123. [PMID: 22527499 DOI: 10.1007/978-3-642-28160-0_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Molecular characterization for circulating tumor cells (CTCs) can be used to better understand the biology of metastasis, to improve patient management and help to identify novel targets for biological therapies aimed to prevent metastatic relapse. New areas of research are directed towards developing novel sensitive assays for CTC molecular characterization. Towards this direction, molecular detection technologies that take advantage of the extreme sensitivity and specificity of PCR, offer many advantages, such as high sensitivity, specificity, and significant flexibility in the clinical lab setting, in terms of high-throughput analysis, multiplexing, and quality control issues. Using molecular assays, a variety of molecular markers such as multiple gene expression, DNA methylation markers, DNA mutations, and miRNAs have been detected and quantified in CTCs in various cancer types, enabling their molecular characterization. Here, we present the main molecular detection technologies currently used for CTC analysis and molecular characterization.
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Affiliation(s)
- Evi S Lianidou
- Laboratory of Analytical Chemistry, Department of Chemistry, University of Athens, 15771, Athens, Greece,
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27
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Kim P, Liu X, Lee T, Liu L, Barham R, Kirkland R, Leesman G, Kuller A, Ybarrondo B, Ng SC, Singh S. Highly sensitive proximity mediated immunoassay reveals HER2 status conversion in the circulating tumor cells of metastatic breast cancer patients. Proteome Sci 2011; 9:75. [PMID: 22172159 PMCID: PMC3271991 DOI: 10.1186/1477-5956-9-75] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/15/2011] [Indexed: 01/28/2023] Open
Abstract
Background The clinical benefits associated with targeted oncology agents are generally limited to subsets of patients. Even with favorable biomarker profiles, many patients do not respond or acquire resistance. Existing technologies are ineffective for treatment monitoring as they provide only static and limited information and require substantial amounts of tissue. Therefore, there is an urgent need to develop methods that can profile potential therapeutic targets with limited clinical specimens during the course of treatment. Methods We have developed a novel proteomics-based assay, Collaborative Enzyme Enhanced Reactive-immunoassay (CEER) that can be used for analyzing clinical samples. CEER utilizes the formation of unique immuno-complex between capture-antibodies and two additional detector-Abs on a microarray surface. One of the detector-Abs is conjugated to glucose oxidase (GO), and the other is conjugated to Horse Radish Peroxidase (HRP). Target detection requires the presence of both detector-Abs because the enzyme channeling event between GO and HRP will not occur unless both Abs are in close proximity. Results CEER was able to detect single-cell level expression and phosphorylation of human epidermal growth factor receptor 2 (HER2) and human epidermal growth factor receptor 1 (HER1) in breast cancer (BCa) systems. The shift in phosphorylation profiles of receptor tyrosine kinases (RTKs) and other signal transduction proteins upon differential ligand stimulation further demonstrated extreme assay specificity in a multiplexed array format. HER2 analysis by CEER in 227 BCa tissues showed superior accuracy when compared to the outcome from immunohistochemistry (IHC) (83% vs. 96%). A significant incidence of HER2 status alteration with recurrent disease was observed via circulating tumor cell (CTC) analysis, suggesting an evolving and dynamic disease progression. HER2-positive CTCs were found in 41% (7/17) while CTCs with significant HER2-activation without apparent over-expression were found in 18% (3/17) of relapsed BCa patients with HER2-negative primary tumors. The apparent 'HER2 status conversion' observed in recurrent BCa may have significant implications on understanding breast cancer metastasis and associated therapeutic development. Conclusion CEER can be multiplexed to analyze pathway proteins in a comprehensive manner with extreme specificity and sensitivity. This format is ideal for analyzing clinical samples with limited availability.
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Affiliation(s)
- Phillip Kim
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Xinjun Liu
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Tani Lee
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Limin Liu
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Robert Barham
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Richard Kirkland
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Glen Leesman
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Anne Kuller
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Belen Ybarrondo
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Shi-Chung Ng
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
| | - Sharat Singh
- Department of Research & Development, Oncology, Prometheus Laboratories, 9410 Carroll Park Dr., San Diego, CA 92121, USA
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28
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Lianidou ES, Markou A. Circulating tumor cells in breast cancer: detection systems, molecular characterization, and future challenges. Clin Chem 2011; 57:1242-55. [PMID: 21784769 DOI: 10.1373/clinchem.2011.165068] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Circulating tumor cell (CTC) analysis is a promising new diagnostic field for estimating the risk for metastatic relapse and metastatic progression in patients with cancer. CONTENT Different analytical systems for CTC isolation and detection have been developed as immunocytochemical and molecular assays, most including separation steps by size or biological characteristics, such as expression of epithelial- or cancer-specific markers. Recent technical advancements in CTC detection and characterization include methods based on multiplex reverse-transcription quantitative PCR and approaches based on imaging and microfilter and microchip devices. New areas of research are directed toward developing novel assays for CTC molecular characterization. QC is an important issue for CTC analysis, and standardization of micrometastatic cell detection and characterization methodologies is important for the incorporation of CTCs into prospective clinical trials to test their clinical utility. The molecular characterization of CTCs can provide important information on the molecular and biological nature of these cells, such as the status of hormone receptors and epidermal and other growth factor receptor family members, and indications of stem-cell characteristics. This information is important for the identification of therapeutic targets and resistance mechanisms in CTCs as well as for the stratification of patients and real-time monitoring of systemic therapies. SUMMARY CTC analysis can be used as a liquid biopsy approach for prognostic and predictive purposes in breast and other cancers. In this review we focus on state-of-the-art technology platforms for CTC isolation, imaging, and detection; QC of CTC analysis; and ongoing challenges for the molecular characterization of CTCs.
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Affiliation(s)
- Evi S Lianidou
- Laboratory of Analytical Chemistry, Department of Chemistry, University of Athens, Athens, Greece.
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Zhang L, Wu G, Pantel K. Detection of circulating tumor cells by RT-PCR significantly associated with poor prognosis in breast cancer. Breast Cancer Res Treat 2011; 130:359-64. [PMID: 21691818 DOI: 10.1007/s10549-011-1636-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/08/2011] [Indexed: 11/28/2022]
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Prognostic value of HER2-positive circulating tumor cells in patients with metastatic breast cancer. Int J Clin Oncol 2011; 17:96-104. [PMID: 21671160 DOI: 10.1007/s10147-011-0260-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/16/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUNDS The presence of ≥5 circulating tumor cells (CTCs) in 7.5 ml blood is a poor prognostic marker in metastatic breast cancer (MBC). However, the role of human epidermal growth factor receptor 2 (HER2) status in CTCs is not known. METHODS We prospectively assessed the prognostic value of this parameter for patients with MBC who started a new line of systemic therapy. The CTC count (≥5 or <5) and the HER2 status in CTCs at the initiation of the therapy and 3-4 weeks later (first follow-up) were determined. RESULTS The median follow-up time of the 52 enrolled patients was 655.0 days (18-1,275 days). HER2-positive CTCs were present in 14 of the 52 patients (26.9%) during the study period. Eight of 33 patients (24.2%) with HER2-negative primary tumors had HER2-positive CTCs during the study period. At first follow-up, patients with HER2-positive CTCs had significantly shorter progression-free (n = 6; P = 0.001) and overall (P = 0.013) survival than did patients without HER2-positive CTCs (n = 43) in log-rank analysis. In multivariate analysis, HER2-positive CTCs at first follow-up (P = 0.029) and the number of therapies patients received before this study (P = 0.006) were independent prognostic factors in terms of progression-free survival. The number of therapies (P = 0.001) and a count of ≥5 CTCs (P = 0.043) at baseline were independent prognostic factors in terms of overall survival. CONCLUSIONS We showed that HER2 status in CTCs may be a prognostic factor for MBC. Well-powered prospective studies are necessary to determine the potential role of HER2-targeted therapies for patients with HER2-positive CTCs and HER2-negative primary tumors.
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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.
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Affiliation(s)
- Chuanli Ren
- Clinical Laboratory, Medical College of Yangzhou University, Yangzhou
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Mathelin C, Croce S, Rault S, Gharbi M, Eichler F, Gairard B, Coumaros G, Koehl C. Doit-on doser le marqueur circulant ECD/HER-2 chez les patientes atteintes d’un cancer mammaire ? Presse Med 2011; 40:126-37. [DOI: 10.1016/j.lpm.2010.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 10/01/2010] [Indexed: 02/08/2023] Open
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Graves H, Czerniecki BJ. Circulating tumor cells in breast cancer patients: an evolving role in patient prognosis and disease progression. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:621090. [PMID: 21253472 PMCID: PMC3022182 DOI: 10.4061/2011/621090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 12/09/2010] [Indexed: 12/30/2022]
Abstract
In this paper, we examine the role of circulating tumor cells (CTCs) in breast cancer. CTCs are tumor cells present in the peripheral blood. They are found in many different carcinomas but are not present in patients with benign disease. Recent advances in theories regarding metastasis support the role of early release of tumor cells in the neoplastic process. Furthermore, it has been found that phenotypic variation exists between the primary tumor and CTCs. Of particular interest is the incongruency found between primary tumor and CTC HER2 status in both metastatic and early breast cancer. Overall, CTCs have been shown to be a poor prognostic marker in metastatic breast cancer. CTCs in early breast cancer are not as well studied, however, several studies suggest that the presence of CTCs in early breast cancer may also suggest a poorer prognosis. Studies are currently underway looking at the use of CTC level monitoring in order to guide changes in therapy.
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Affiliation(s)
- Holly Graves
- Harrison Department of Surgical Research, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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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]
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Riethdorf S, Müller V, Zhang L, Rau T, Loibl S, Komor M, Roller M, Huober J, Fehm T, Schrader I, Hilfrich J, Holms F, Tesch H, Eidtmann H, Untch M, von Minckwitz G, Pantel K. Detection and HER2 expression of circulating tumor cells: prospective monitoring in breast cancer patients treated in the neoadjuvant GeparQuattro trial. Clin Cancer Res 2010; 16:2634-45. [PMID: 20406831 DOI: 10.1158/1078-0432.ccr-09-2042] [Citation(s) in RCA: 373] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This study was aimed at detecting and characterizing circulating tumor cells (CTC) before and after neoadjuvant therapy (NT) in the peripheral blood of patients with breast cancer. EXPERIMENTAL DESIGN The clinical trial GeparQuattro incorporated NT approaches (epirubicin/cyclophosphamide prior to randomization to docetaxel alone, docetaxel in combination with capecitabine, or docetaxel followed by capecitabine) and additional trastuzumab treatment for patients with HER2-positive tumors. We used the Food and Drug Administration-approved CellSearch system for CTC detection and evaluation of HER2 expression and developed HER2 immunoscoring for CTC. RESULTS We detected > or =1 CTC/7.5 mL in 46 of 213 patients (21.6%) before NT and in 22 of 207 patients (10.6%) after NT (P = 0.002). Twenty (15.0%) initially CTC-positive cases were CTC-negative after NT, whereas 11 (8.3%) cases were CTC-positive after NT, although no CTC could be found before NT. CTC detection did not correlate with primary tumor characteristics. Furthermore, there was no association between tumor response to NT and CTC detection. HER2-overexpressing CTC were observed in 14 of 58 CTC-positive patients (24.1%), including 8 patients with HER2-negative primary tumors and 3 patients after trastuzumab treatment. CTC scored HER2-negative or weakly HER2-positive before or after NT were present in 11 of 21 patients with HER2-positive primary tumors. HER2 overexpression on CTC was restricted to ductal carcinomas and associated with high tumor stage (P = 0.002). CONCLUSION CTC number was low in patients with primary breast cancer. The decrease in CTC incidence during treatment was not correlated with standard clinical characteristics and primary tumor response. Information on the HER2 status of CTC might be helpful for stratification and monitoring of HER2-directed therapies.
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Affiliation(s)
- Sabine Riethdorf
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Shafiee H, Sano MB, Henslee EA, Caldwell JL, Davalos RV. Selective isolation of live/dead cells using contactless dielectrophoresis (cDEP). LAB ON A CHIP 2010; 10:438-45. [PMID: 20126683 DOI: 10.1039/b920590j] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Contactless dielectrophoresis (cDEP) is a recently developed method of cell manipulation in which the electrodes are physically isolated from the sample. Here we present two microfluidic devices capable of selectively isolating live human leukemia cells from dead cells utilizing their electrical signatures. The effect of different voltages and frequencies on the gradient of the electric field and device performance was investigated numerically and validated experimentally. With these prototype devices we were able to achieve greater than 95% removal efficiency at 0.2-0.5 mm s(-1) with 100% selectivity between live and dead cells. In conjunction with enrichment, cDEP could be integrated with other technologies to yield fully automated lab-on-a-chip systems capable of sensing, sorting, and identifying rare cells.
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Affiliation(s)
- Hadi Shafiee
- Engineering Science and Mechanics Department, Virginia Tech, Blacksburg, VA 24061, USA.
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Saloustros E, Mavroudis D. Cytokeratin 19-positive circulating tumor cells in early breast cancer prognosis. Future Oncol 2010; 6:209-19. [DOI: 10.2217/fon.09.147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In spite of the heterogeneity of breast cancer at the molecular level, circulating tumor cells (CTCs) may provide a novel prognostic marker. Approximately 20–40% of early breast cancer patients have detectable CTCs using reverse transcription PCR for CK19. The detection of CTCs before adjuvant chemotherapy or during tamoxifen administration has been demonstrated to be an independent adverse prognostic factor in women with early-stage breast cancer. The prognostic value of CTC detection is of great significance in subgroups of patients with estrogen receptor-negative and human EGF receptor 2-positive tumors. Prospective clinical trials are warranted in order to validate the use of CTCs as predictive and/or prognostic markers and assess their utility in individualizing therapy of patients with early breast cancer.
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Affiliation(s)
| | - Dimitris Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Voutes, 71110 Heraklion, Crete, Greece
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Circulating tumour cells in clinical practice: Methods of detection and possible characterization. Methods 2010; 50:289-97. [PMID: 20116432 DOI: 10.1016/j.ymeth.2010.01.027] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/08/2010] [Accepted: 01/18/2010] [Indexed: 01/10/2023] Open
Abstract
Circulating Tumour Cells (CTCs) can be released from the primary tumour into the bloodstream and may colonize distant organs giving rise to metastasis. The presence of CTCs in the blood has been documented more than a century ago, and in the meanwhile various methods have been described for their detection. Most of them require an initial enrichment step, since CTCs are a very rare event. The different technologies and also the differences among the screened populations make the clinical significance of CTCs detection difficult to interprete. Here we will review the different assays up to now available for CTC detection and analysis. Moreover, we will focus on the relevance of the clinical data, generated so far and based on the CTCs analysis. Since the vast majority of data have been produced in breast cancer patients, the review will focus especially on this malignancy.
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Abstract
Circulating tumor cells (CTCs) can be separated and characterized from normal hematopoietic cellular constituents by a variety of methods. Different strategies have included separation by physical characteristics, such as size or weight, or by biological characteristics, such as expression of epithelial or cancer-specific markers. Of the latter, rtPCR for epithelial-related gene message, such as cytokeratin, and immunoseparation techniques using monoclonal antibodies against epithelial cellular adhesion molecule, have gained the most widespread use in investigational and standard clinical application to date. Detection and monitoring of CTCs might be useful for screening, prognosis, prediction of response to therapy, or monitoring clinical course in patients with primary or metastatic cancer. Currently, monitoring patients with metastatic disease is the most practical application of CTCs. In this regard, several studies have demonstrated that approximately 50-70% of patients with metastatic breast, colon, and prostate cancers have elevated CTC levels, when evaluated using a highly automated immunomagnetic CTC assay system, designated CellSearch®. These studies demonstrate that elevated CTC levels prior to initiation of a new systemic therapy are associated with a worse prognosis than those that do not, and that persistently elevated or subsequent rising CTC levels strongly suggest that the therapeutic regimen with which the patient is being treated is not working. Similar results have been shown with rtPCR assays, although they are not as widely available for routine clinical use. New areas of research are directed toward developing more sensitive means of CTC detection and generating a variety of methods to characterize the molecular and biologic nature of CTCs, such as the status of hormone receptors, epidermal, and other growth factor receptor family members, and indications of stem-cell characteristics.
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Affiliation(s)
- Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
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Milanezi F, Leitão D, Ricardo S, Augusto I, Schmitt F. Evaluation of HER2 in breast cancer: reality and expectations. ACTA ACUST UNITED AC 2009; 3:607-20. [PMID: 23496046 DOI: 10.1517/17530050903222221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The introduction of drugs, whose mechanisms of action are directed against specific molecules involved in cancer initiation and/or progression, has changed the daily workup of breast cancer patients. At present, HER2 expression and/or amplification should be evaluated in every primary invasive breast cancer either at the time of diagnosis or at the time of recurrence, mostly to guide selection of trastuzumab in the adjuvant and/or metastatic setting. The adequate selection of patients is an essential step for indication of anti-HER2 therapy. OBJECTIVE This review focuses on the state of the art for HER2 evaluation in breast cancer, as well as expectations regarding future molecular assays based on mechanisms of resistance to HER2-driven therapy. METHODS Data were obtained by searching the PubMed database, including the terms 'HER2', 'in situ hybridisation', 'immunohistochemistry', 'trastuzumab', 'breast cancer', 'therapy', 'resistance' and 'tyrosine-kinase inhibitors', with a preference for updated publications. CONCLUSION Pathologists have a central role in the selection of patients who will benefit from anti-HER-based therapies, with a responsibility to obtain the most reliable results for immunohistochemistry and in situ hybridisation techniques. Pre-analytical variables, such as type of fixative and time of fixation, are critical to guarantee consistent and quality assays, as well as to facilitate interpretation and decrease interobserver variability. Rigorous quality control and centralisation of techniques/interpretation of results are recommended to guarantee consistent assays.
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Affiliation(s)
- Fernanda Milanezi
- Institute of Molecular Pathology and Immunology of Porto University, Rua Roberto Frias, s/n, 4200-465, Porto, Portugal +351 225570700 ; +351 225570799 ;
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Mostert B, Sleijfer S, Foekens JA, Gratama JW. Circulating tumor cells (CTCs): detection methods and their clinical relevance in breast cancer. Cancer Treat Rev 2009; 35:463-74. [PMID: 19410375 DOI: 10.1016/j.ctrv.2009.03.004] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 03/20/2009] [Accepted: 03/30/2009] [Indexed: 01/31/2023]
Abstract
The enumeration of circulating tumor cells has long been regarded as an attractive diagnostic tool, as circulating tumor cells are thought to reflect aggressiveness of the tumor and may assist in therapeutic decisions in patients with solid malignancies. However, implementation of this assay into clinical routine has been cumbersome, as a validated test was not available until recently. Circulating tumor cells are rare events which can be detected specifically only by using a combination of surface and intracellular markers, and only recently a number of technical advances have made their reliable detection possible. Most of these new techniques rely on a combination of an enrichment and a detection step. This review addresses the assays that have been described so far in the literature, including the enrichment and detection steps and the markers used in these assays. We have focused on breast cancer as most clinical studies on CTC detection so far have been done in these patients.
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Affiliation(s)
- Bianca Mostert
- Department of Medical Oncology, Erasmus Medical Center - Josephine Nefkens Institute and Cancer Genomics Centre, 3015 GE Rotterdam, The Netherlands.
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Gascoyne PRC, Noshari J, Anderson TJ, Becker FF. Isolation of rare cells from cell mixtures by dielectrophoresis. Electrophoresis 2009; 30:1388-98. [PMID: 19306266 PMCID: PMC3754902 DOI: 10.1002/elps.200800373] [Citation(s) in RCA: 344] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The application of dielectrophoretic field-flow fractionation (depFFF) to the isolation of circulating tumor cells (CTCs) from clinical blood specimens was studied using simulated cell mixtures of three different cultured tumor cell types with peripheral blood. The depFFF method can not only exploit intrinsic tumor cell properties so that labeling is unnecessary but can also deliver unmodified, viable tumor cells for culture and/or all types of molecular analysis. We investigated tumor cell recovery efficiency as a function of cell loading for a 25 mm wide x 300 mm long depFFF chamber. More than 90% of tumor cells were recovered for small samples but a larger chamber will be required if similarly high recovery efficiencies are to be realized for 10 mL blood specimens used CTC analysis in clinics. We show that the factor limiting isolation efficiency is cell-cell dielectric interactions and that isolation protocols should be completed within approximately 15 min in order to avoid changes in cell dielectric properties associated with ion leakage.
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Affiliation(s)
- Peter R C Gascoyne
- Department of Molecular Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Ignatiadis M, Georgoulias V, Mavroudis D. Micrometastatic disease in breast cancer: clinical implications. Eur J Cancer 2009; 44:2726-36. [PMID: 19056036 DOI: 10.1016/j.ejca.2008.09.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 09/23/2008] [Indexed: 01/22/2023]
Abstract
The presence of bone marrow disseminated tumour cells (DTCs) was shown to predict poor clinical outcome in early breast cancer. However, peripheral blood is easier to obtain and allows for serial monitoring of minimal residual disease. Towards this aim, circulating tumour cells (CTCs) in the blood are detected using either direct methods, mainly antibody-based assays (immunocytochemistry, immunofluorescence and flow cytometry), or indirect methods, mainly nucleic acid-based assays (detection of mRNA transcripts by reverse transcriptase polymerase chain reaction, RT-PCR). The detection of CTCs using RT-PCR for CK19 was shown to be an independent prognostic factor in women with early breast cancer. Furthermore, considerable progress has been accomplished in genotyping, phenotyping and profiling micrometastatic cells. The challenge now is to integrate minimal residual disease as a prognostic and predictive tool in the management of breast cancer. This requires the standardisation of micrometastatic cell detection and characterisation, which will allow the incorporation of CTCs/DTCs into prospective clinical trials testing their clinical utility.
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Affiliation(s)
- Michail Ignatiadis
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
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HER2 as marker for the detection of circulating tumor cells. Breast Cancer Res Treat 2008; 117:535-7. [PMID: 19115105 DOI: 10.1007/s10549-008-0276-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 12/09/2008] [Indexed: 10/21/2022]
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Detection of occult HER2 mRNA-positive tumor cells in the peripheral blood of patients with operable breast cancer: evaluation of their prognostic relevance. Breast Cancer Res Treat 2008; 117:525-34. [DOI: 10.1007/s10549-008-0239-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
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Evaluation of international treatment guidelines and prognostic tests for the treatment of early breast cancer. Cancer Treat Rev 2008; 34:701-9. [PMID: 18922644 DOI: 10.1016/j.ctrv.2008.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/11/2008] [Accepted: 04/15/2008] [Indexed: 11/20/2022]
Abstract
The clinical decision to treat early-stage breast cancer with adjuvant chemotherapy is sometimes a difficult one because 70-80% of patients who receive chemotherapy would probably have survived without it. To help clinicians in this decision-making process, different tools or 'decision aids' have been developed for the treatment of early breast cancer over the years. Some of these tools include clinical treatment guidelines and computer-based programs as well as different prognostic and/or predictive tests such as those based on gene expression profiles or the presence minimum invasive disease. All of these tools try to individualize as much as possible the estimation of the risk of breast cancer relapse and death and to facilitate the clinical decision about giving additional treatment, and ultimately the most appropriate treatment to be given. Thus, it is important for clinicians to be aware of not only the existence of these tools or 'decision aids', but also to know how they have been developed, how frequently there are revised and if they have been validated. In order to address all these concerns, we have carried out a critical review of the most important prognostic tests and clinical guidelines for the treatment of early breast cancer. Information regarding their development process as well as frequency of revision, validations that have been performed and main limitations of each tool were gathered and critically analyzed.
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Alix-Panabières C, Riethdorf S, Pantel K. Circulating tumor cells and bone marrow micrometastasis. Clin Cancer Res 2008; 14:5013-21. [PMID: 18698019 DOI: 10.1158/1078-0432.ccr-07-5125] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sensitive immunocytochemical and molecular assays allow the detection of single circulating tumor cells (CTC) in the peripheral blood and disseminated tumor cells (DTC) in the bone marrow as a common and easily accessible homing organ for cells released by epithelial tumors of various origins. The results obtained thus far have provided direct evidence that tumor cell dissemination starts already early during tumor development and progression. Tumor cells are frequently detected in the blood and bone marrow of cancer patients without clinical or even histopathologic signs of metastasis. The detection of DTC and CTC yields important prognostic information and might help to tailor systemic therapies to the individual needs of a cancer patient. In the present review, we provide a critical review of (a) the current methods used for detection of CTC/DTC and (b) data on the molecular characterization of CTC/DTC with a particular emphasis on tumor dormancy, cancer stem cell theory, and novel targets for biological therapies; and we pinpoint to (c) critical issues that need to be addressed to establish CTC/DTC measurements in clinical practice.
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Ignatiadis M, Kallergi G, Ntoulia M, Perraki M, Apostolaki S, Kafousi M, Chlouverakis G, Stathopoulos E, Lianidou E, Georgoulias V, Mavroudis D. Prognostic value of the molecular detection of circulating tumor cells using a multimarker reverse transcription-PCR assay for cytokeratin 19, mammaglobin A, and HER2 in early breast cancer. Clin Cancer Res 2008; 14:2593-600. [PMID: 18451221 DOI: 10.1158/1078-0432.ccr-07-4758] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the prognostic value of the molecular detection of circulating tumor cells (CTCs) using three markers [cytokeratin 19 (CK19), mammaglobin A (MGB1), and HER2] in early breast cancer. EXPERIMENTAL DESIGN CK19mRNA+, MGB1mRNA+, and HER2mRNA+ cells were detected using real-time (CK19) and nested (MGB1 and HER2) reverse transcription-PCR in the peripheral blood of 175 women with stage I to III breast cancer before the initiation of adjuvant chemotherapy. The detection of CTCs was correlated with clinical outcome. In 10 patients, immunofluorescence staining experiments were done to investigate the coexpression of cytokeratin, MGB1, and HER2 in CTCs. RESULTS CK19mRNA+, MGB1mRNA+, and HER2mRNA+ cells were detected in 41.1%, 8%, and 28.6% of the 175 patients, respectively. Patients had one of the following molecular profiles: CK19mRNA+/MGB1mRNA+/HER2mRNA+ (n = 8), CK19mRNA+/MGB1mRNA+/HER2mRNA- (n = 1), CK19mRNA+/MGB1mRNA-/HER2mRNA+ (n = 42), CK19mRNA+/MGB1mRNA-/HER2mRNA- (n = 21), CK19mRNA-/MGB1mRNA+/HER2mRNA- (n = 5), and CK19mRNA-/MGB1mRNA-/HER2mRNA- (n = 98). Double-immunofluorescence experiments confirmed the following CTC phenotypes: CK+/MGB1+, CK+/MGB1-, CK-/MGB1+, CK+/HER2+, CK+/HER2-, MGB1+/HER2-, and MGB1+/HER2+. In univariate analysis, the detection of CK19mRNA+, MGB1mRNA+, and HER2mRNA+ cells was associated with shorter disease-free survival (DFS; P < 0.001, P = 0.001, and P < 0.001, respectively), whereas the detection of CK19mRNA+ and MGB1mRNA+ cells was associated with worse overall survival (P = 0.044 and 0.034, respectively). In multivariate analysis, estrogen receptor-negative tumors and the detection of CK19mRNA+ and MGB1mRNA+ cells were independently associated with worse DFS. CONCLUSION The detection of peripheral blood CK19mRNA+ and MGB1mRNA+ cells before adjuvant chemotherapy predicts poor DFS in women with early breast cancer.
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Affiliation(s)
- Michail Ignatiadis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece.
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Pantel K, Brakenhoff RH, Brandt B. Detection, clinical relevance and specific biological properties of disseminating tumour cells. Nat Rev Cancer 2008; 8:329-40. [PMID: 18404148 DOI: 10.1038/nrc2375] [Citation(s) in RCA: 927] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Most cancer deaths are caused by haematogenous metastatic spread and subsequent growth of tumour cells at distant organs. Disseminating tumour cells present in the peripheral blood and bone marrow can now be detected and characterized at the single-cell level. These cells are highly relevant to the study of the biology of early metastatic spread and provide a diagnostic source in patients with overt metastases. Here we review the evidence that disseminating tumour cells have a variety of uses for understanding tumour biology and improving cancer treatment.
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Affiliation(s)
- Klaus Pantel
- Institute of Tumour Biology, Center of Experimental Medicine, University Medical Center Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.
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