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Rodriguez-Tirado C, Sosa MS. How much do we know about the metastatic process? Clin Exp Metastasis 2024; 41:275-299. [PMID: 38520475 PMCID: PMC11374507 DOI: 10.1007/s10585-023-10248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/17/2023] [Indexed: 03/25/2024]
Abstract
Cancer cells can leave their primary sites and travel through the circulation to distant sites, where they lodge as disseminated cancer cells (DCCs), even during the early and asymptomatic stages of tumor progression. In experimental models and clinical samples, DCCs can be detected in a non-proliferative state, defined as cellular dormancy. This state can persist for extended periods until DCCs reawaken, usually in response to niche-derived reactivation signals. Therefore, their clinical detection in sites like lymph nodes and bone marrow is linked to poor survival. Current cancer therapy designs are based on the biology of the primary tumor and do not target the biology of the dormant DCC population and thus fail to eradicate the initial or subsequent waves of metastasis. In this brief review, we discuss the current methods for detecting DCCs and highlight new strategies that aim to target DCCs that constitute minimal residual disease to reduce or prevent metastasis formation. Furthermore, we present current evidence on the relevance of DCCs derived from early stages of tumor progression in metastatic disease and describe the animal models available for their study. We also discuss our current understanding of the dissemination mechanisms utilized by genetically less- and more-advanced cancer cells, which include the functional analysis of intermediate or hybrid states of epithelial-mesenchymal transition (EMT). Finally, we raise some intriguing questions regarding the clinical impact of studying the crosstalk between evolutionary waves of DCCs and the initiation of metastatic disease.
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Affiliation(s)
- Carolina Rodriguez-Tirado
- Department of Microbiology and Immunology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
- Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
- Cancer Dormancy and Tumor Microenvironment Institute/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
- Ruth L. and David S. Gottesman Institute for Stem Cell Research and Regenerative Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
| | - Maria Soledad Sosa
- Department of Microbiology and Immunology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
- Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
- Cancer Dormancy and Tumor Microenvironment Institute/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
- Ruth L. and David S. Gottesman Institute for Stem Cell Research and Regenerative Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 10461, USA.
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2
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Alkhafaji S, Wolf DM, Magbanua MJM, J van 't Veer L, Park JW, Esserman L, Mukhtar RA. Circulating tumor cells in early lobular versus ductal breast cancer and their associations with prognosis. NPJ Breast Cancer 2024; 10:17. [PMID: 38409268 PMCID: PMC10897340 DOI: 10.1038/s41523-024-00623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
This is a secondary data analysis of the TIPPING study, which included 1,121 patients with stage I-III breast cancer who had enumeration of CTCs (by either CellSearch or immunomagnetic enrichment and flow cytometry [IE/FC]) and disseminated tumor cells (DTCs) at the time of surgical resection between 1999 and 2012. The primary endpoint was mean number of CTCs by histology, taking into account method of detection and treatment type, and evaluation of histology specific prognostic cutpoints. Overall, patients with ILC had significantly higher CTC counts than those with IDC, a finding which persisted in the 382 patients with CTC enumeration by IE/FC method. Additionally, among those with primary surgery, patients with ILC had significantly higher mean CTC counts than those with IDC (mean 2.11 CTCs/mL versus 0.71 CTCs/mL respectively, p < 0.001), which persisted on multivariate analysis. Patients with ILC and CTC-high/DTC-high status trended towards reduced DRFS HR = 9.27, 95% CI 0.95-90.5, p = 0.055) and had significantly decreased BCSS (HR = 10.4, 95% CI 1.07-99.7, P = 0.043) compared with those who were CTC-low/DTC-low. In the IDC group, CTC-high/DTC-high status was not associated with either DRFS or BCSS. In neoadjvuantly treated patients, there was no significant difference in CTC counts in the ILC group versus the IDC group (mean 0.89 CTCs/mL versus 1.06 CTCs/mL respectively, p = 0.82). Our findings contribute to the limited literature on CTCs and DTCs in ILC, and suggest that clinical utility and optimal thresholds for CTC and DTC assays may differ by histologic subtype in early-stage breast cancer.
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Affiliation(s)
- Silver Alkhafaji
- Department of Labaratory Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Denise M Wolf
- Department of Labaratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mark Jesus M Magbanua
- Department of Labaratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura J van 't Veer
- Department of Labaratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John W Park
- Department of Hematology/Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Esserman
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Rita A Mukhtar
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
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3
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Murray NP. Biomarkers of minimal residual disease and treatment. Adv Clin Chem 2024; 119:33-70. [PMID: 38514211 DOI: 10.1016/bs.acc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Minimal residual disease (MRD) has been defined as a very small numbers of cancer cells that remain in the body after curative treatment. Its presence or absence will ultimately determine prognosis. With the introduction of new technologies the presence of MRD in patients with solid tumours can be detected and characterized. As MRD predicts future relapse, be it early or late treatment failure, in an otherwise asymptomatic patient its treatment and when to start treatment remains to be determined. Thus the concepts of personalized medicine using different biomarkers to classify the biological properties of MRD maybe come possible. Based on this determinations it may be possible to use targeted therapies rather than all patients with the same type of cancer receiving a standard treatment. However, it is important to understand the limitations of the different technologies, what these techniques are detecting and how they may help in the treatment of patients with cancer. The majority of published studies are in patients with metastatic cancer and there are few reports in patients with MRD. In this chapter the concept of MRD, the methods used to detect it and what treatments may be effective based on the biological characteristics of the tumour cells as determined by different biomarkers is reviewed. MRD depends on the phenotypic properties of the tumour cells to survive in their new environment and the anti-tumour immune response. This is a dynamic process and changes with time in the wake of immunosuppression caused by the tumour cells and/or the effects of treatment to select resistant tumour cells. With the use of biomarkers to typify the characteristics of MRD and the development of new drugs a personalized treatment can be designed rather than all patients given the same treatment. Patients who are initially negative for MRD may not require further treatment with liquid biopsies used to monitor the patients during follow-up in order to detect those patients who may become MRD positive. The liquid biopsy used during the follow up of MRD positive patients can be used to detect changes in the biological properties of the tumour cells and thus may need treatment changes to overcome tumour cell resistance.
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Affiliation(s)
- Nigel P Murray
- Minimal Residual Disease Laboratory, Faculty of Medicine, University Finis Terrae, Santiago, Chile.
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4
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Multi-Parameter Analysis of Disseminated Tumor Cells (DTCs) in Early Breast Cancer Patients with Hormone-Receptor-Positive Tumors. Cancers (Basel) 2023; 15:cancers15030568. [PMID: 36765527 PMCID: PMC9913363 DOI: 10.3390/cancers15030568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients with hormone-receptor-positive (HR+) breast cancer are at increased risk for late recurrence. One reason might be disseminated tumor cells (DTCs), which split off in the early stages of the disease and metastasize into the bone marrow (BM). METHODS We developed a novel multi-parameter immunofluorescence staining protocol using releasable and bleachable antibody-fluorochrome-conjugates. This sequential procedure enabled us to analyze six distinct phenotypical and therapy-related markers on the same DTC. We characterized BM aspirates from 29 patients with a HR+ tumor and a known positive DTC status-based on the standardized detection of epithelial cells in BM. RESULTS Using the immunofluorescence staining, a total of 153 DTCs were detected. Luminal A patients revealed a higher DTC count compared with luminal B. The majority of the detected DTCs were CK-positive (128/153). However, in 16 of 17 luminal A patients we found HER2-positive DTCs. We detected CK-negative DTCs (25/153) in 12 of 29 patients. Of those cells, 76% were Ki67-positive and 68% were HER2-positive. Moreover, we detected DTC clusters consisting of mixed characteristics in 6 of 29 patients. CONCLUSIONS Using sequential multi-parameter imaging made it possible to identify distinct DTC profiles not solely based on epithelial features. Our findings indicate that characterization rather than quantification of DTCs might be relevant for treatment decisions.
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Hu D, Wang C, Zheng S, Cui X. Investigating the genealogy of the literature on digital pathology: a two-dimensional bibliometric approach. Scientometrics 2022. [DOI: 10.1007/s11192-021-04224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Danila DC. Liquid biopsy as a cancer biomarker-potential, and challenges. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Non-Tumor CCAAT/Enhancer-Binding Protein Delta Potentiates Tumor Cell Extravasation and Pancreatic Cancer Metastasis Formation. Biomolecules 2021; 11:biom11081079. [PMID: 34439745 PMCID: PMC8391339 DOI: 10.3390/biom11081079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022] Open
Abstract
CCAAT/enhancer-binding protein delta (C/EBPδ) is a transcription factor involved in apoptosis and proliferation, which is downregulated in pancreatic ductal adenocarcinoma (PDAC) cells. Loss of nuclear C/EBPδ in PDAC cells is associated with decreased patient survival and pro-tumorigenic properties in vitro. Interestingly however, next to C/EBPδ expression in tumor cells, C/EBPδ is also expressed by cells constituting the tumor microenvironment and by cells comprising the organs and parenchyma. However, the functional relevance of systemic C/EBPδ in carcinogenesis remains elusive. Here, we consequently assessed the potential importance of C/EBPδ in somatic tissues by utilizing an orthotopic pancreatic cancer model. In doing so, we show that genetic ablation of C/EBPδ does not significantly affect primary tumor growth but has a strong impact on metastases; wildtype mice developed metastases at multiple sites, whilst this was not the case in C/EBPδ-/- mice. In line with reduced metastasis formation in C/EBPδ-/- mice, C/EBPδ-deficiency also limited tumor cell dissemination in a specific extravasation model. Tumor cell extravasation was dependent on the platelet-activating factor receptor (PAFR) as a PAFR antagonist inhibited tumor cell extravasation in wildtype mice but not in C/EBPδ-/- mice. Overall, we show that systemic C/EBPδ facilitates pancreatic cancer metastasis, and we suggest this is due to C/EBPδ-PAFR-dependent tumor cell extravasation.
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8
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Disseminated tumour cells from the bone marrow of early breast cancer patients: Results from an international pooled analysis. Eur J Cancer 2021; 154:128-137. [PMID: 34265505 DOI: 10.1016/j.ejca.2021.06.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Presence of disseminated tumour cells (DTCs) in the bone marrow (BM) has been described as a surrogate of residual disease in patients with early breast cancer (EBC). PADDY (Pooled Analysis of DTC Detection in Early Breast Cancer) is a large international analysis of pooled data that aimed to assess the prognostic impact of DTCs in patients with EBC. EXPERIMENTAL DESIGN Individual patient data were collected from 11 centres. Patients with EBC and available follow-up data in whom BM sampling was performed at the time of primary diagnosis before receiving any anticancer treatment were eligible. DTCs were identified by antibody staining against epithelial cytokeratins. Multivariate Cox regression was used to compare the survival of DTC-positive versus DTC-negative patients. RESULTS In total, 10,307 patients were included. Of these, 2814 (27.3%) were DTC-positive. DTC detection was associated with higher tumour grade, larger tumour size, nodal positivity, oestrogen receptor and progesterone receptor negativity, and HER2 positivity (all p < 0.001). Multivariate analyses showed that DTC detection was an independent prognostic marker for overall survival, disease-free survival and distant disease-free survival with hazard ratios (HR) and 95% confidence intervals (CI) of 1.23 (95% CI: 1.06-1.43, p = 0.006), 1.30 (95% CI: 1.12-1.52, p < 0.001) and 1.30 (95% CI: 1.08-1.56, p = 0.006), respectively. There was no association between locoregional relapse-free survival and DTC detection (HR 1.21; 95% CI 0.68-2.16; p = 0.512). CONCLUSIONS DTCs in the BM represent an independent prognostic marker in patients with EBC. The heterogeneous metastasis-initiating potential of DTCs is consistent with the concept of cancer dormancy.
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Taniguchi H, Natori Y, Miyagi Y, Hayashi K, Nagamura F, Kataoka K, Imai K. Treatment of primary and metastatic breast and pancreatic tumors upon intravenous delivery of a PRDM14-specific chimeric siRNA/nanocarrier complex. Int J Cancer 2021; 149:646-656. [PMID: 33783816 DOI: 10.1002/ijc.33579] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/10/2021] [Accepted: 02/09/2021] [Indexed: 01/28/2023]
Abstract
PRDM14 is highly expressed in several cancers but is not detected in normal tissues. It confers cancer stem cell-like properties, including chemoresistance and distant metastasis, to cancer cells. Herein, we aimed to develop a highly effective therapy against advanced stage cancer based on intravenously delivered PRDM14-targeted siRNA. First, we examined PRDM14 expression and gene amplification in breast and pancreatic tumors and cell lines. PRDM14 was expressed in breast cancer, including the triple-negative subtype, and pancreatic cancer. PRDM14 was amplified in 23.8% of patients with PRDM14+ breast cancer. Next, we investigated the inoculated tumor growth and distant metastasis following PRDM14 depletion by administering mice with PRDM14-specific chimeric siRNA combined with a novel branched PEGylated poly-L-ornithine (PLO)-based intravenous drug delivery system, designated PRDM14 unit polyion complex (uPIC) (n = 6/group). Inhibition of PRDM14 expression with PRDM14 uPIC by systemic intravenous injection effectively reduced tumor size and metastasis in vivo, thereby improving survival. Finally, pharmacokinetic/toxicokinetic analyses were performed on PRDM14 uPIC, which was intravenously administered to rats (n = 10-15/group) and cynomolgus monkeys (n = 3-5/group), twice weekly for 4 weeks. This revealed that PRDM14 uPIC was relatively nontoxic and the siRNA exposure in serum was greater than that predicted by the administered dose ratio when delivered as a uPIC. Taken together, our study indicated that PRDM14 uPIC is highly effective in suppressing malignant features of solid cancers and does not cause severe toxicity, making it a promising therapeutic agent for cancer treatment.
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Affiliation(s)
- Hiroaki Taniguchi
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.,Research and Development Center for Precision Medicine, University of Tsukuba, Innovation Medical Research Institute, Ibaraki, Japan
| | - Yukikazu Natori
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.,BioThinkTank Co. Ltd., Nishi-ku Yokohama, Kanagawa, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Kotaro Hayashi
- Innovation Center of NanoMedicine, Kawasaki Institute of Industrial Promotion, Kawasaki City, Kanagawa Prefecture, Japan
| | - Fumitaka Nagamura
- Translational Research Center, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazunori Kataoka
- Innovation Center of NanoMedicine, Kawasaki Institute of Industrial Promotion, Kawasaki City, Kanagawa Prefecture, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Kohzoh Imai
- Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
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10
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Targeted transcript quantification in single disseminated cancer cells after whole transcriptome amplification. PLoS One 2019; 14:e0216442. [PMID: 31430289 PMCID: PMC6701776 DOI: 10.1371/journal.pone.0216442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022] Open
Abstract
Gene expression analysis of rare or heterogeneous cell populations such as disseminated cancer cells (DCCs) requires a sensitive method allowing reliable analysis of single cells. Therefore, we developed and explored the feasibility of a quantitative PCR (qPCR) assay to analyze single-cell cDNA pre-amplified using a previously established whole transcriptome amplification (WTA) protocol. We carefully selected and optimized multiple steps of the protocol, e.g. re-amplification of WTA products, quantification of amplified cDNA yields and final qPCR quantification, to identify the most reliable and accurate workflow for quantitation of gene expression of the ERBB2 gene in DCCs. We found that absolute quantification outperforms relative quantification. We then validated the performance of our method on single cells of established breast cancer cell lines displaying distinct levels of HER2 protein. The different protein levels were faithfully reflected by transcript expression across the tested cell lines thereby proving the accuracy of our approach. Finally, we applied our method to breast cancer DCCs of a patient undergoing anti-HER2-directed therapy. Here, we were able to measure ERBB2 expression levels in all HER2-protein-positive DCCs. In summary, we developed a reliable single-cell qPCR assay applicable to measure distinct levels of ERBB2 in DCCs.
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11
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Thery L, Meddis A, Cabel L, Proudhon C, Latouche A, Pierga JY, Bidard FC. Circulating Tumor Cells in Early Breast Cancer. JNCI Cancer Spectr 2019; 3:pkz026. [PMID: 31360902 PMCID: PMC6649836 DOI: 10.1093/jncics/pkz026] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/24/2019] [Accepted: 03/27/2019] [Indexed: 12/25/2022] Open
Abstract
Circulating tumor cells (CTCs) are particularly rare in non-metastatic breast cancer, and the clinical validity of CTC detection in that clinical setting was initially not well recognized. A cytological CTC detection device (CellSearch) fulfilling the CLIA requirements for analytical validity was subsequently developed and, in 2008, we reported the first study (REMAGUS02) showing that distant metastasis-free survival was shorter in early breast cancer patients with one or more CTCs. In the past 10 years, other clinical studies and meta-analyses have established CTC detection as a level-of-evidence 1 prognostic biomarker for local relapses, distant relapses, and overall survival. This review summarizes available data on CTC detection and the promises of this proliferation- and subtype-independent metastasis-associated biomarker in early breast cancer patients.
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Affiliation(s)
- Laura Thery
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | | | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Circulating Tumor Biomarkers Laboratory, Institut Curie, Inserm CIC 1428, PSL Research University, Paris, France.,UVSQ, Paris Saclay University, Saint Cloud, France
| | - Charlotte Proudhon
- Circulating Tumor Biomarkers Laboratory, Institut Curie, Inserm CIC 1428, PSL Research University, Paris, France
| | - Aurelien Latouche
- Inserm U900, Institut Curie, Saint Cloud, France.,Conservatoire national des arts et métiers, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Circulating Tumor Biomarkers Laboratory, Institut Curie, Inserm CIC 1428, PSL Research University, Paris, France.,Université Paris Descartes, Paris, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Circulating Tumor Biomarkers Laboratory, Institut Curie, Inserm CIC 1428, PSL Research University, Paris, France.,UVSQ, Paris Saclay University, Saint Cloud, France
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12
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Disseminated Tumor Cells Predict Efficacy of Regional Nodal Irradiation in Early Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2018; 103:389-396. [PMID: 30291993 DOI: 10.1016/j.ijrobp.2018.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Disseminated tumor cells (DTCs) collect in the bone marrow and indicate micrometastatic spread. We previously reported that DTCs could be a predictive factor for the efficacy of regional node irradiation (internal mammary nodes [IMNs]/supra- and infraclavicular nodes [SCNs]). In this article, we report the long-term results (>10 years) on the impact of DTC status in early stage breast cancer. METHODS AND MATERIALS Patients with localized breast cancer were eligible for inclusion in this prospective cohort. DTCs were obtained from a medullary iliac crest sample performed before any primary therapy. DTC status was prospectively assessed by pathologists. Irradiation volumes were defined per standard of care. Cumulative incidence rates and hazard ratios were obtained using both Cox and Fine-Gray models. Interaction tests were performed to confirm the predictive value of DTC status in a multivariate analysis. RESULTS Six hundred twenty patients with localized breast cancer were included. Overall, 94 patients (15.2%) were DTC-positive. After a median follow-up of 11.7 years, 47 patients (7.6%) experienced locoregional relapse. DTC detection was associated with a higher risk of locoregional relapse in univariate and multivariate analyses (Cox hazard ratio, 3.26; 95% confidence interval, 1.6-5.7; P = .001). In the multivariate subgroup analysis, IMN/SCN irradiation significantly reduced locoregional relapse among DTC-positive patients compared with DTC-negative patients (interaction test: hazard ratio, 0.3; 95% confidence interval, 0.1-0.9; P = .02). IMN/SCN was the only irradiation volume with an impact on locoregional relapse in patients according to DTC status, and the predictive value of DTC status for the benefit of locoregional irradiation was independent of locoregional nodal status. CONCLUSIONS This long-term analysis confirms the predictive impact of DTC status on the efficacy of regional radiation therapy for locoregional relapse in early breast cancer. After further studies, DTC status could be used as a decision tool to better tailor adjuvant radiation therapy in patients with early stage breast cancer.
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Nicolini A, Ferrari P, Duffy MJ. Prognostic and predictive biomarkers in breast cancer: Past, present and future. Semin Cancer Biol 2018; 52:56-73. [DOI: 10.1016/j.semcancer.2017.08.010] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 12/19/2022]
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14
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Hench IB, Hench J, Tolnay M. Liquid Biopsy in Clinical Management of Breast, Lung, and Colorectal Cancer. Front Med (Lausanne) 2018; 5:9. [PMID: 29441349 PMCID: PMC5797586 DOI: 10.3389/fmed.2018.00009] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 12/12/2022] Open
Abstract
Examination of tumor molecular characteristics by liquid biopsy is likely to greatly influence personalized cancer patient management. Analysis of circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and tumor-derived exosomes, all collectively referred to as “liquid biopsies,” are not only a modality to monitor treatment efficacy, disease progression, and emerging therapy resistance mechanisms, but they also assess tumor heterogeneity and evolution in real time. We review the literature concerning the examination of ctDNA and CTC in a diagnostic setting, evaluating their prognostic, predictive, and monitoring capabilities. We discuss the advantages and limitations of various leading ctDNA/CTC analysis technologies. Finally, guided by the results of clinical trials, we discuss the readiness of cell-free DNA and CTC as routine biomarkers in the context of various common types of neoplastic disease. At this moment, one cannot conclude whether or not liquid biopsy will become a mainstay in oncology practice.
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Affiliation(s)
- Ivana Bratić Hench
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Jürgen Hench
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Markus Tolnay
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
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15
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Xiao Y, Shen M, Shi X. Design of functional electrospun nanofibers for cancer cell capture applications. J Mater Chem B 2018; 6:1420-1432. [DOI: 10.1039/c7tb03347h] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The review reports recent advances in the design of functional electrospun nanofibers for cancer cell capture applications.
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Affiliation(s)
- Yunchao Xiao
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials
- College of Chemistry
- Chemical Engineering and Biotechnology
- Donghua University
- Shanghai 201620
| | - Mingwu Shen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials
- College of Chemistry
- Chemical Engineering and Biotechnology
- Donghua University
- Shanghai 201620
| | - Xiangyang Shi
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials
- College of Chemistry
- Chemical Engineering and Biotechnology
- Donghua University
- Shanghai 201620
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16
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Kumar N, Zaw AS, Kantharajanna SB, Khoo BL, Lim CT, Thiery JP. Metastatic efficiency of tumour cells can be impaired by intraoperative cell salvage process: truth or conjecture? Transfus Med 2017; 27 Suppl 5:327-334. [PMID: 28833768 DOI: 10.1111/tme.12453] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023]
Abstract
The use of salvaged blood in oncological surgery has been a matter of controversy over the years. This is due to the concern of systemic dissemination of reinfused tumour cells. Recent literature, across disciplines, has shed considerable light on its safety in terms of tumour recurrence, progression and overall survival rates. This clinical safety demonstrates the apparent metastatic inefficiency of reinfused tumour cells. The proof of this concept comes from various studies that have shown that salvaged blood has no tumour cells, or has a significantly lower count as compared to the patient's original circulatory tumour load. Recently, we took a step further and found that the tumour cells in the salvaged blood lose the capacity to replicate. In this review, we revisited the safety of salvaged blood from the point of view of metastatic potential. We have presented basic and applied science evidence regarding the innocuous nature of tumour cells that have been subjected to the cell salvage process. The understanding of the metastatic efficiency or the lack of it in tumour cells subjected to salvage process is key to allay the concerns conventionally associated with the use of salvaged blood in tumour surgery. Based on the available literature, we surmise that the prevalent apprehensions on the usage of salvaged blood are ill-founded and further substantiate why tumour cells in the salvaged blood could be regarded as cells with non-metastatic potential.
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Affiliation(s)
- N Kumar
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - A S Zaw
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - S B Kantharajanna
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - B L Khoo
- BioSystems and Micromechanics (BioSyM) Inter-Disciplinary Research Group, Singapore MIT Alliance for Research and Technology (SMART), National University of Singapore, Singapore, Singapore
| | - C T Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - J P Thiery
- BioSystems and Micromechanics (BioSyM) Inter-Disciplinary Research Group, Singapore MIT Alliance for Research and Technology (SMART), National University of Singapore, Singapore, Singapore
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17
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Alvarez Cubero MJ, Lorente JA, Robles-Fernandez I, Rodriguez-Martinez A, Puche JL, Serrano MJ. Circulating Tumor Cells: Markers and Methodologies for Enrichment and Detection. Methods Mol Biol 2017; 1634:283-303. [PMID: 28819860 DOI: 10.1007/978-1-4939-7144-2_24] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cancer is a leading cause of disease worldwide; however, nowadays many points of its initiation processes are unknown. In this chapter, we are focusing on the role of liquid biopsies in cancer detection and progression. CTCs are one of the main components of liquid biopsies, they represent a subset of tumor cells that have acquired the ability to disseminate from the primary tumor and intravasate to the circulatory system. The greatest challenge in the detection of CTCs is their rarity in the blood. Human blood consists of white blood cells (5-10 × 106/mL), red blood cells (5-9 × 109/mL), and platelets (2.5-4 × 108/mL); very few CTCs will be present even in patients with known metastatic disease, with often less than one CTC per mL of blood. CTCs are found in frequencies on the order of 1-10 CTCs per mL of whole blood in patients with metastatic disease, and it is reduced in half for non-metastatic stages. Therefore, accurate methodologies for their capture and analysis are really important. The main aim of the present chapter is to describe different methodologies for CTCs capturing and analysis.
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MESH Headings
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/metabolism
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Biomarkers, Tumor/metabolism
- Cell Count
- Cell Line, Tumor
- Cell Separation/instrumentation
- Cell Separation/methods
- Cell Survival
- Centrifugation, Density Gradient/methods
- Epithelial Cell Adhesion Molecule/genetics
- Epithelial Cell Adhesion Molecule/immunology
- Epithelial Cell Adhesion Molecule/metabolism
- Epithelial-Mesenchymal Transition/genetics
- Equipment Design
- ErbB Receptors/genetics
- ErbB Receptors/immunology
- ErbB Receptors/metabolism
- Ficoll/chemistry
- Fluorescent Dyes/chemistry
- Humans
- Immunoassay
- Keratins/genetics
- Keratins/immunology
- Keratins/metabolism
- Microfluidic Analytical Techniques/instrumentation
- Neoplasms/blood
- Neoplasms/diagnosis
- Neoplasms/immunology
- Neoplasms/pathology
- Neoplastic Cells, Circulating/immunology
- Neoplastic Cells, Circulating/metabolism
- Neoplastic Cells, Circulating/pathology
- Protein Binding
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Affiliation(s)
- M J Alvarez Cubero
- GENYO. Centre for Genomics and Oncological Research, Pfizer, University of Granada, Andalusian Regional Government, Av. de la Ilustración 114, 18016, Granada, Spain.
| | - J A Lorente
- GENYO. Centre for Genomics and Oncological Research, Pfizer, University of Granada, Andalusian Regional Government, Av. de la Ilustración 114, 18016, Granada, Spain
- Laboratory of Genetic Identification, University of Granada-Dept. of Legal Medicine - Faculty of Medicine, Granada, 18016, Spain
| | - I Robles-Fernandez
- GENYO. Centre for Genomics and Oncological Research, Pfizer, University of Granada, Andalusian Regional Government, Av. de la Ilustración 114, 18016, Granada, Spain
| | - A Rodriguez-Martinez
- GENYO. Centre for Genomics and Oncological Research, Pfizer, University of Granada, Andalusian Regional Government, Av. de la Ilustración 114, 18016, Granada, Spain
- Laboratory of Genetic Identification, University of Granada-Dept. of Legal Medicine - Faculty of Medicine, Granada, 18016, Spain
| | - J L Puche
- Integral Oncology Division, Clinical University Hospitals of Granada, Av. de las Fuerzas Armadas, 2, 18014, Granada, Spain
| | - M J Serrano
- GENYO. Centre for Genomics and Oncological Research, Pfizer, University of Granada, Andalusian Regional Government, Av. de la Ilustración 114, 18016, Granada, Spain
- Integral Oncology Division, Clinical University Hospitals of Granada, Av. de las Fuerzas Armadas, 2, 18014, Granada, Spain
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18
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Wang H, Wu X. Detection and Enumeration of Circulating Tumor Cells with Invasive Phenotype. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 994:133-141. [PMID: 28560672 DOI: 10.1007/978-3-319-55947-6_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Circulating tumor cells (CTCs) disseminate from solid primary cancers into the peripheral blood and lymphatic vessels and can lead to metastatic tumor development; thus, CTC assays are an important clinical tool for monitoring progression and evaluating prognosis in cancer. However, CTCs are limited in number and heterogeneous in their biological and physical properties, making their detection, isolation, and enumeration a major challenge. To overcome these difficulties, novel techniques have been developed to detect and enumerate CTCs with an invasive phenotype. In this chapter, we will summarize these recently developed methods and detail two novel methods for capturing and enriching CTCs on the basis of their viability and their invasive properties.
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Affiliation(s)
- Haizhen Wang
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Xiangwei Wu
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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19
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Shahriyari L. A new hypothesis: some metastases are the result of inflammatory processes by adapted cells, especially adapted immune cells at sites of inflammation. F1000Res 2016; 5:175. [PMID: 27158448 PMCID: PMC4847566 DOI: 10.12688/f1000research.8055.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 02/06/2023] Open
Abstract
There is an old hypothesis that metastasis is the result of migration of tumor cells from the tumor to a distant site. In this article, we propose another mechanism for metastasis, for cancers that are initiated at the site of chronic inflammation. We suggest that cells at the site of chronic inflammation might become adapted to the inflammatory process, and these adaptations may lead to the initiation of an inflammatory tumor. For example, in an inflammatory tumor immune cells might be adapted to send signals of proliferation or angiogenesis, and epithelial cells might be adapted to proliferation (like inactivation of tumor suppressor genes). Therefore, we hypothesize that metastasis could be the result of an inflammatory process by adapted cells, especially adapted immune cells at the site of inflammation, as well as the migration of tumor cells with the help of activated platelets, which travel between sites of inflammation. If this hypothesis is correct, then any treatment causing necrotic cell death may not be a good solution. Because necrotic cells in the tumor micro-environment or anywhere in the body activate the immune system to initiate the inflammatory process, and the involvement of adapted immune cells in the inflammatory processes leads to the formation and progression of tumors. Adapted activated immune cells send more signals of proliferation and/or angiogenesis than normal cells. Moreover, if there were adapted epithelial cells, they would divide at a much higher rate in response to the proliferation signals than normal cells. Thus, not only would the tumor come back after the treatment, but it would also grow more aggressively.
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Affiliation(s)
- Leili Shahriyari
- Mathematical Biosciences Institute, The Ohio State University, Columbus, OH, USA
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20
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Ji JL, Jiang YZ, Tang QQ, He XD, Shen ZJ, Zhang BY. Detection of Circulating Tumor Cells Using a Novel Immunomagnetic Bead Method in Lung Cancer Patients. J Clin Lab Anal 2016; 30:656-62. [PMID: 26987307 DOI: 10.1002/jcla.21918] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 11/08/2015] [Accepted: 11/16/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Circulating tumor cells (CTCs) are detectable in peripheral blood of metastatic lung cancer patients. In this article, we evaluate a new CTC separation method based on a combination of anti-EpCAM and immunomagnetic beads with the aim to detect CTCs more conveniently and specifically. METHODS Lung cancer cells were magnetically labeled by anti-EpCAM magnetic beads, and subsequently captured by magnetic separation using our novel device. Isolated lung cancer cells were identified by pathomorphological by hematoxylin-eosin staining protocol. The system was used to detect CTCs in 2 ml blood. Blood samples of healthy donors spiked with lung cancer cell line A549 cells were used to determine the sensitivity and specificity of the method. Prevalence of CTCs was examined in samples from 56 patients with lung cancer. RESULTS Regression analysis of number of recovered versus spiked A549 cells yielded a coefficient of determination of R(2) = 0.996 (P < 0.001). The average recovery was 68% or more at each spiking level. The coefficient of variation increased as the number of spiked cells decreased, ranging from 6.4% (1,000-cell spike) to 18.4% (50-cell spike). Forty-nine of the fifty-six patients (87.5%) were found to have CTCs in peripheral blood. None of the 2 ml peripheral blood samples of the 20 healthy subjects analyzed were found to have CTCs. CONCLUSIONS This novel turbulence device provides a new tool allowing for feasible and specific detection of CTCs in lung cancer patients. It is likely clinically useful in diagnosis and monitoring of lung cancer and may have a role in clinical decision making.
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Affiliation(s)
- Jin-Ling Ji
- Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Yu-Zhang Jiang
- Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Qian-Qiu Tang
- Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Xiao-Dong He
- Anhui Provincial Center for Clinical Laboratories, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Zuo-Jun Shen
- Anhui Provincial Center for Clinical Laboratories, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
| | - Bai-Yin Zhang
- Anhui Provincial Center for Clinical Laboratories, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
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21
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Bidard FC, Proudhon C, Pierga JY. Circulating tumor cells in breast cancer. Mol Oncol 2016; 10:418-30. [PMID: 26809472 PMCID: PMC5528978 DOI: 10.1016/j.molonc.2016.01.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/12/2015] [Accepted: 01/04/2016] [Indexed: 01/06/2023] Open
Abstract
Over the past decade, technically reliable circulating tumor cell (CTC) detection methods allowed the collection of large datasets of CTC counts in cancer patients. These data can be used either as a dynamic prognostic biomarker or as tumor material for “liquid biopsy”. Breast cancer appears to be the cancer type in which CTC have been the most extensively studied so far, with level‐of‐evidence‐1 studies supporting the clinical validity of CTC count in both early and metastatic stage. This review summarizes and discusses the clinical results obtained in breast cancer patients, the issues faced by the molecular characterization of CTC and the biological findings about cancer biology and metastasis that were obtained from CTC. In metastatic breast cancer, CTC count is a level‐of‐evidence 1 prognostic dynamic biomarker. Several interventional trials are ongoing to demonstrate the clinical utility of CTC detection in metastatic breast cancer. In early breast cancer, CTC count is also a prognostic biomarker, not correlated with the other usual prognostic factors. Molecular characterization of CTC is promising, trials with anti‐HER2 therapy are ongoing.
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Affiliation(s)
- Francois-Clement Bidard
- Institut Curie, PSL Research University, SiRIC, Laboratory of Circulating Tumor Biomarkers, Paris, France; Institut Curie, PSL Research University, Department of Medical Oncology, Paris, France
| | - Charlotte Proudhon
- Institut Curie, PSL Research University, SiRIC, Laboratory of Circulating Tumor Biomarkers, Paris, France
| | - Jean-Yves Pierga
- Institut Curie, PSL Research University, SiRIC, Laboratory of Circulating Tumor Biomarkers, Paris, France; Institut Curie, PSL Research University, Department of Medical Oncology, Paris, France; Université Paris Descartes, Paris, France.
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22
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Tanaka F, Yoneda K. Adjuvant therapy following surgery in non-small cell lung cancer (NSCLC). Surg Today 2016; 46:25-37. [PMID: 25925615 DOI: 10.1007/s00595-015-1174-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/19/2015] [Indexed: 01/13/2023]
Abstract
Non-small cell lung cancer (NSCLC) accounts for 80-90 % of cases of primary lung cancer. Although surgery is recommended as the primary treatment for early-stage NSCLC, the prognosis is unsatisfactory even when complete resection is achieved. Recent clinical trials have shown that postoperative adjuvant chemotherapy with cytotoxic agents, namely uracil-tegafur (UFT) for stage IA (>2 cm in diameter)-IB patients or cisplatin-based regimens for stage II-IIIA patients, improves the prognosis, and adjuvant chemotherapy is recommended as the "standard treatment of care." However, adjuvant chemotherapy provides only a modest 5-year survival benefit of 4 % and may sometimes be fatal. To improve the risk-benefit balance of adjuvant chemotherapy, targeting agents such as antibodies against vascular endothelial growth factor (VEGF) and tyrosine-kinase inhibitors of epidermal growth factor receptor (EGFR-TKIs) are being evaluated in ongoing adjuvant trials. Another promising approach may be the individualization of adjuvant chemotherapy based on biomarkers that may predict the prognosis or benefits associated with adjuvant chemotherapy. The current status and future perspectives of adjuvant chemotherapy for NSCLC are reviewed and discussed.
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Affiliation(s)
- Fumihiro Tanaka
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahata-nishi-ku, Kitakyusyu, 807-8555, Japan.
| | - Kazue Yoneda
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahata-nishi-ku, Kitakyusyu, 807-8555, Japan
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23
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Cortesi E, Palleschi M, Magri V, Naso G. The promise of liquid biopsy in cancer: a clinical perspective. Chin J Cancer Res 2015; 27:488-90. [PMID: 26543335 DOI: 10.3978/j.issn.1000-9604.2015.10.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The clinical utility of liquid biopsy in cancer treatment will increase as circulating tumor cells (CTCs) analysis move from the enumeration to the real-time measurement of tumor characteristics. Intratumor heterogeneity is becoming increasingly recognized as a major drawback to the shift to personalized medicine. Spatial and temporal heterogeneity might be reflected by the serial assessment of CTCs. Indeed, the developing technologies for CTCs analysis now allow digital genomic and next-generation sequencing approaches, able to differentiate molecular subtypes of the disease and to monitor genetic variation over time. The liquid biopsy of cancer might offer a real-time assessment of tumor biology, providing the opportunity to serially evaluate patients most likely to benefit from targeted drugs based on a dynamic characterization of the disease at the molecular level. Although hurdles remain before liquid biopsy is seen in routine clinical practice, the information derived from CTCs may facilitate the real-time identification of actionable mutations in cancer leading the way toward personalized medicine.
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Affiliation(s)
- Enrico Cortesi
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | - Michela Palleschi
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | - Valentina Magri
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | - Giuseppe Naso
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
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24
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Yunokawa M, Tsuta K, Tanaka T, Nara E, Koizumi F, Ito J, Sekine S, Fujiwara Y, Tamura K. Back with a vengeance: microvascular tumor embolism. Am J Med 2015; 128:834-6. [PMID: 25912204 DOI: 10.1016/j.amjmed.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/05/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Koji Tsuta
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Tanaka
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Eriko Nara
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumiaki Koizumi
- Department of Clinical Examinations, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Junko Ito
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenji Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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Abstract
Molecular characterization of circulating tumor cells (CTCs) found in the blood of cancer patients offers the potential to provide new insights into the biology of cancer metastasis. However, since they are rare and difficult to isolate, the molecular nature of CTCs remains poorly understood. In this paper, we reviewed a decade's worth of scientific literature (2003-2013) describing efforts on isolation and genomic analysis of CTCs. The limited number of CTC genomic studies we found attested to the infancy of this field of study. These initial reports, however, provide an important framework for future comprehensive exploration of CTC biology. For CTCs to be broadly accepted as therapeutic targets and biomarkers of metastatic spread, further in-depth molecular characterization is warranted.
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26
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Toss A, Mu Z, Fernandez S, Cristofanilli M. CTC enumeration and characterization: moving toward personalized medicine. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:108. [PMID: 25489582 DOI: 10.3978/j.issn.2305-5839.2014.09.06] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/28/2014] [Indexed: 12/27/2022]
Abstract
The primary cause of tumor-related death in breast cancer (BC) is still represented by distant metastasization. The dissemination of tumor cells from the primary tumor to distant sites through bloodstream cannot be early detected by standard imaging methods. The enumeration of circulating tumor cells (CTCs) represents an effective prognostic and predictive biomarker, which is able to monitor efficacy of adjuvant therapies, detect early development of (micro)metastases and at last, assess therapeutic responses of advanced disease earlier than traditional imaging methods. Moreover, since repeated tissue biopsies are invasive, costly and not always feasible, the assessment of tumor characteristics on CTCs, by a peripheral blood sample as a 'liquid biopsy', represents an attractive opportunity. The implementation of molecular and genomic characterization of CTCs could contribute to improve the treatment selection and thus, to move toward more personalized treatments. This review describes the current state of the art on CTC detection strategies, the evidence to demonstrate their clinical validity, and their potential impact for both future clinical trial design and, decision-making process in our daily practice.
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Affiliation(s)
- Angela Toss
- 1 Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy ; 2 Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA, USA
| | - Zhaomei Mu
- 1 Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy ; 2 Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA, USA
| | - Sandra Fernandez
- 1 Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy ; 2 Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA, USA
| | - Massimo Cristofanilli
- 1 Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy ; 2 Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA, USA
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27
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Circulating tumor cells in breast cancer and its association with tumor clinicopathological characteristics: a meta-analysis. Med Oncol 2014; 31:343. [DOI: 10.1007/s12032-014-0343-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
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28
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Naume B, Synnestvedt M, Falk RS, Wiedswang G, Weyde K, Risberg T, Kersten C, Mjaaland I, Vindi L, Sommer HH, Sætersdal AB, Rypdal MC, Bendigtsen Schirmer C, Wist EA, Borgen E. Clinical outcome with correlation to disseminated tumor cell (DTC) status after DTC-guided secondary adjuvant treatment with docetaxel in early breast cancer. J Clin Oncol 2014; 32:3848-57. [PMID: 25366688 DOI: 10.1200/jco.2014.56.9327] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The presence of disseminated tumor cells (DTCs) in bone marrow (BM) predicts survival in early breast cancer. This study explores the use of DTCs for identification of patients insufficiently treated with adjuvant therapy so they can be offered secondary adjuvant treatment and the subsequent surrogate marker potential of DTCs for outcome determination. PATIENTS AND METHODS Patients with early breast cancer who had completed six cycles of adjuvant fluorouracil, epirubicin, and cyclophosphamide (FEC) chemotherapy underwent BM aspiration 2 to 3 months (BM1) and 8 to 9 months (BM2) after FEC. Presence of DTCs in BM was determined by immunocytochemistry using pan-cytokeratin monoclonal antibodies. If one or more DTCs were present at BM2, six cycles of docetaxel (100 mg/m(2), once every 3 weeks) were administered, followed by DTC analysis 1 and 13 months after the last docetaxel infusion (after treatment). Cox regression analysis was used to evaluate disease-free interval (DFI). RESULTS Of 1,066 patients with a DTC result at BM2 and available follow-up information (median follow-up, 71.9 months from the time of BM2), 7.2% were DTC positive. Of 72 docetaxel-treated patients analyzed for DTCs after treatment, 15 (20.8%) had persistent DTCs. Patients with remaining DTCs had markedly reduced DFI (46.7% experienced relapse) compared with patients with no DTCs after treatment (adjusted hazard ratio, 7.58; 95% CI, 2.3 to 24.7). The docetaxel-treated patients with no DTCs after treatment had comparable DFI (8.8% experienced relapse) compared with those with no DTCs both at BM1 and BM2 (12.7% experienced relapse; P = .377, log-rank test). CONCLUSION DTC status identifies high-risk patients after FEC chemotherapy, and DTC monitoring status after secondary treatment with docetaxel correlated strongly with survival. This emphasizes the potential for DTC analysis as a surrogate marker for adjuvant treatment effect in breast cancer.
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Affiliation(s)
- Bjørn Naume
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway.
| | - Marit Synnestvedt
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Ragnhild Sørum Falk
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Gro Wiedswang
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Kjetil Weyde
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Terje Risberg
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Christian Kersten
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Ingvil Mjaaland
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Lise Vindi
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Hilde H Sommer
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Anna Barbro Sætersdal
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Maria Christine Rypdal
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Cecilie Bendigtsen Schirmer
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Erik Andreas Wist
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
| | - Elin Borgen
- Bjørn Naume, Marit Synnestvedt, Ragnhild Sørum Falk, Gro Wiedswang, Hilde H. Sommer, Anna Barbro Sætersdal, Maria Christine Rypdal, Cecilie Bendigtsen Schirmer, Erik Andreas Wist, and Elin Borgen, Oslo University Hospital; Bjørn Naume, Erik Andreas Wist, and Elin Borgen, K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, University of Oslo, Oslo; Kjetil Weyde, Sykehuset Innlandet Trust, Gjøvik; Terje Risberg, University Hospital of Northern Norway and University of Tromsø, Tromsø; Christian Kersten, Sørlandet Hospital Trust, Kristiansand; Ingvil Mjaaland, Stavanger University Hospital, Stavanger; and Lise Vindi, Ålesund Hospital, Ålesund, Norway
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Hartkopf AD, Taran FA, Wallwiener M, Hahn M, Becker S, Solomayer EF, Brucker SY, Fehm TN, Wallwiener D. Prognostic relevance of disseminated tumour cells from the bone marrow of early stage breast cancer patients – Results from a large single-centre analysis. Eur J Cancer 2014; 50:2550-9. [DOI: 10.1016/j.ejca.2014.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/06/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
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Walter CB, Taran FA, Wallwiener M, Rothmund R, Kraemer B, Krawczyk N, Blassl C, Melcher C, Wallwiener D, Fehm T, Hartkopf AD. Prevalence and prognostic value of disseminated tumor cells in primary endometrial, cervical and vulvar cancer patients. Future Oncol 2014; 10:41-8. [PMID: 24328408 DOI: 10.2217/fon.13.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Disseminated tumor cell (DTC) detection in bone marrow (BM) of primary breast cancer patients predicts poor prognosis. This study investigates the prevalence of DTCs and their prognostic significance in primary gynecologic malignancies. PATIENTS & METHODS DTCs from BM aspirates of 603 patients with endometrial (311), cervical (228) and vulvar cancer (64) were identified by the pancytokeratin antibody A45B/B3. RESULTS DTCs were detected in 18% of BM aspirates (21, 16 and 16% in endometrial, cervical and vulvar cancer, respectively). In cervical cancer, DTCs were associated with International Federation of Gynecology and Obstetrics stage, nodal status and lymphangiosis. There was no association between BM status and prognosis. CONCLUSION Tumor cell dissemination is common in gynecological cancer. In contrast to breast cancer, DTCs that derive from cervical, endometrial or vulvar cancer have less potential to initiate metastatic regrow. The molecular mechanisms underlying this observation warrant further investigation.
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Affiliation(s)
- Christina Barbara Walter
- Department of Obstetrics & Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
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Tumor cell dissemination to the bone marrow and blood is associated with poor outcome in patients with metastatic breast cancer. Breast Cancer Res Treat 2014; 147:345-51. [DOI: 10.1007/s10549-014-3113-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Tewes M, Kasimir-Bauer S, Welt A, Schuler M, Kimmig R, Aktas B. Detection of disseminated tumor cells in bone marrow and circulating tumor cells in blood of patients with early-stage male breast cancer. J Cancer Res Clin Oncol 2014; 141:87-92. [DOI: 10.1007/s00432-014-1784-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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Werner-Klein M, Proske J, Werno C, Schneider K, Hofmann HS, Rack B, Buchholz S, Ganzer R, Blana A, Seelbach-Göbel B, Nitsche U, Männel DN, Klein CA. Immune humanization of immunodeficient mice using diagnostic bone marrow aspirates from carcinoma patients. PLoS One 2014; 9:e97860. [PMID: 24830425 PMCID: PMC4022674 DOI: 10.1371/journal.pone.0097860] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/24/2014] [Indexed: 01/18/2023] Open
Abstract
Tumor xenografts in immunodeficient mice, while routinely used in cancer research, preclude studying interactions of immune and cancer cells or, if humanized by allogeneic immune cells, are of limited use for tumor-immunological questions. Here, we explore a novel way to generate cancer models with an autologous humanized immune system. We demonstrate that hematopoietic stem and progenitor cells (HSPCs) from bone marrow aspirates of non-metastasized carcinoma patients, which are taken at specialized centers for diagnostic purposes, can be used to generate a human immune system in NOD-scid IL2rγ(null) (NSG) and HLA-I expressing NSG mice (NSG-HLA-A2/HHD) comprising both, lymphoid and myeloid cell lineages. Using NSG-HLA-A2/HHD mice, we show that responsive and self-tolerant human T cells develop and human antigen presenting cells can activate human T cells. As critical factors we identified the low potential of bone marrow HSPCs to engraft, generally low HSPC numbers in patient-derived bone marrow samples, cryopreservation and routes of cell administration. We provide here an optimized protocol that uses a minimum number of HSPCs, preselects high-quality bone marrow samples defined by the number of initially isolated leukocytes and intra-femoral or intra-venous injection. In conclusion, the use of diagnostic bone marrow aspirates from non-metastasized carcinoma patients for the immunological humanization of immunodeficient mice is feasible and opens the chance for individualized analyses of anti-tumoral T cell responses.
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Affiliation(s)
| | - Judith Proske
- Institute of Immunology, University of Regensburg, Regensburg, Germany
| | - Christian Werno
- Project Group Personalized Tumor Therapy, Fraunhofer Institute of Toxicology and Experimental Medicine, Regensburg, Germany
| | - Katharina Schneider
- Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | | | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefan Buchholz
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Roman Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Andreas Blana
- Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Regensburg, Germany
| | - Ulrich Nitsche
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniela N. Männel
- Institute of Immunology, University of Regensburg, Regensburg, Germany
| | - Christoph A. Klein
- Project Group Personalized Tumor Therapy, Fraunhofer Institute of Toxicology and Experimental Medicine, Regensburg, Germany
- Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
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Evaluation of two different analytical methods for circulating tumor cell detection in peripheral blood of patients with primary breast cancer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:491459. [PMID: 24800234 PMCID: PMC3997081 DOI: 10.1155/2014/491459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/23/2014] [Accepted: 02/27/2014] [Indexed: 12/12/2022]
Abstract
Background. Evidence is accumulating that circulating tumor cells (CTC) out of peripheral blood can serve as prognostic marker not only in metastatic but also in early breast cancer (BC). Various methods are available to detect CTC. Comparisons between the different techniques, however, are rare. Material and Methods. We evaluate two different methods for CTC enrichment and detection in primary BC patients: the FDA-approved CellSearch System (CSS; Veridex, Warren, USA) and a manual immunocytochemistry (MICC). The cut-off value for positivity was ≥1 CTC. Results. The two different nonoverlapping patient cohorts evaluated with one or the other method were well balanced regarding common clinical parameters. Before adjuvant CHT 21.1% (416 out of 1972) and 20.6% (247 out of 1198) of the patients were CTC-positive, while after CHT 22.5% (359 out of 1598) and 16.6% (177 out of 1066) of the patients were CTC-positive using CSS or MICC, respectively. CTC positivity rate before CHT was thus similar and not significantly different (P = 0.749), while CTC positivity rate immediately after CHT was significantly lower using MICC compared to CSS (P < 0.001). Conclusion. Using CSS or MICC for CTC detection, we found comparable prevalence of CTC before but not after adjuvant CHT.
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Markiewicz A, Książkiewicz M, Wełnicka-Jaśkiewicz M, Seroczyńska B, Skokowski J, Szade J, Żaczek AJ. Mesenchymal phenotype of CTC-enriched blood fraction and lymph node metastasis formation potential. PLoS One 2014; 9:e93901. [PMID: 24709997 PMCID: PMC3977989 DOI: 10.1371/journal.pone.0093901] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/09/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Circulating tumor cells (CTCs) that present mesenchymal phenotypes can escape standard methods of isolation, thus limiting possibilities for their characterization. Whereas mesenchymal CTCs are considered to be more malignant than epithelial CTCs, factors responsible for this aggressiveness have not been thoroughly defined. This study analyzed the molecular profile related to metastasis formation potential of CTC-enriched blood fractions obtained by marker unbiased isolation from breast cancer patients without (N−) and with lymph nodes metastases (N+). Materials and Methods Blood samples drawn from 117 patients with early-stage breast cancer were enriched for CTCs using density gradient centrifugation and negative selection with anti-CD45 covered magnetic particles. In the resulting CTC-enriched blood fractions, expression of CK19, MGB1, VIM, TWIST1, SNAIL, SLUG, HER2, CXCR4 and uPAR was analyzed with qPCR. Results were correlated with patients' clinicopathological data. Results CTCs (defined as expression of either CK19, MGB1 or HER2) were detected in 41% (20/49) of N− and 69% (34/49) of N+ patients (P = 0.004). CTC-enriched blood fractions of N+ patients were more frequently VIM (P = 0.02), SNAIL (P = 0.059) and uPAR-positive (P = 0.03). Positive VIM, CXCR4 and uPAR status correlated with >3 lymph nodes involved (P = 0.003, P = 0.01 and P = 0.045, respectively). In the multivariate logistic regression MGB1 and VIM-positivity were independently related to lymph node involvement with corresponding overall risk of 3.2 and 4.2. Moreover, mesenchymal CTC-enriched blood fractions (CK19−/VIM+ and MGB1+ or HER2+) had 4.88 and 7.85-times elevated expression of CXCR4 and uPAR, respectively, compared with epithelial CTC-enriched blood fractions (CK19+/VIM− and MGB1+ or HER2+). Conclusions Tumors of N+ patients have superior CTC-seeding and metastatic potential compared with N- patients. These differences can be attributed to VIM, uPAR and CXCR4 expression, which endow tumor cells with particularly malignant phenotypes.
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Affiliation(s)
- Aleksandra Markiewicz
- Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Książkiewicz
- Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | | | - Barbara Seroczyńska
- Bank of Frozen Tissues and Genetic Specimens, Department of Medical Laboratory Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
| | - Jarosław Skokowski
- Bank of Frozen Tissues and Genetic Specimens, Department of Medical Laboratory Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
- Department of Surgical Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jolanta Szade
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna J. Żaczek
- Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
- * E-mail:
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Schneble EJ, Graham LJ, Shupe MP, Flynt FL, Banks KP, Kirkpatrick AD, Nissan A, Henry L, Stojadinovic A, Shumway NM, Avital I, Peoples GE, Setlik RF. Future directions for the early detection of recurrent breast cancer. J Cancer 2014; 5:291-300. [PMID: 24790657 PMCID: PMC3982042 DOI: 10.7150/jca.8017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The main goal of follow-up care after breast cancer treatment is the early detection of disease recurrence. In this review, we emphasize the multidisciplinary approach to this continuity of care from surgery, medical oncology, and radiology. Challenges within each setting are briefly addressed as a means of discussion for the future directions of an effective and efficient surveillance plan of post-treatment breast cancer care.
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Affiliation(s)
- Erika J Schneble
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Lindsey J Graham
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Matthew P Shupe
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Frederick L Flynt
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Kevin P Banks
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Aaron D Kirkpatrick
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Aviram Nissan
- 2. Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel
| | - Leonard Henry
- 3. IU Health Goshen, 200 High Park Ave., Goshen, IN 46526, USA
| | | | - Nathan M Shumway
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Itzhak Avital
- 4. Bon Secours Cancer Institute, 5855 Bremo Road, Richmond, VA 23226, USA
| | - George E Peoples
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Robert F Setlik
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
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Disseminated tumor cells as a monitoring tool for adjuvant therapy in patients with primary breast cancer. Breast Cancer Res Treat 2014; 144:353-60. [PMID: 24554386 DOI: 10.1007/s10549-014-2853-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
The presence of disseminated tumor cells (DTC) in the bone marrow (BM) of early breast cancer patients at initial surgery as well as during follow-up predicts an unfavorable outcome. This study aimed to assess whether adjuvant systemic therapy has the ability to eradicate DTC and to determine the clinical impact of DTC-persistence. Between 12 and 24 months after an initial BM aspiration during primary surgery (BMA1) a second and third bone marrow aspiration (BMA2 and BMA3, respectively) was performed. DTC were identified by immunocytochemistry (pancytokeratin antibody A45-B/B3) and cytomorphology. A total of 190 patients who were DTC-positive at BMA1 were eligible for this retrospective analysis. DTC persisted in 35 of 190 (19 %) patients at BMA2 and in 11 of 71 (16 %) patients at BMA3. DTC-persistence at BMA3 was significantly lower in patients that received adjuvant endocrine therapy (p = 0.017). At BMA2, DTC-positive patients were at an increased risk of disease recurrence (HR: 4.17, 95 % CI: 1.51-11.50, p = 0.003) and death (HR: 5.02, 95 % CI: 1.156-21.83, p = 0.031). At BMA3, the presence of DTC was associated with shorter disease free survival (HR: 3.20, 95 % CI: 1.05-9.78, p = 0.010). In conclusion, a majority of initially DTC-positive primary breast cancer patients turned negative during adjuvant treatment. As DTC-persistence predicted an adverse outcome, serial DTC-determination can identify patients that will probably benefit from additional or a switch of adjuvant therapy.
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Park S, Ang RR, Duffy SP, Bazov J, Chi KN, Black PC, Ma H. Morphological differences between circulating tumor cells from prostate cancer patients and cultured prostate cancer cells. PLoS One 2014; 9:e85264. [PMID: 24416373 PMCID: PMC3885705 DOI: 10.1371/journal.pone.0085264] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/25/2013] [Indexed: 12/01/2022] Open
Abstract
Circulating tumor cell (CTC) enumeration promises to be an important predictor of clinical outcome for a range of cancers. Established CTC enumeration methods primarily rely on affinity capture of cell surface antigens, and have been criticized for underestimation of CTC numbers due to antigenic bias. Emerging CTC capture strategies typically distinguish these cells based on their assumed biomechanical characteristics, which are often validated using cultured cancer cells. In this study, we developed a software tool to investigate the morphological properties of CTCs from patients with castrate resistant prostate cancer and cultured prostate cancer cells in order to establish whether the latter is an appropriate model for the former. We isolated both CTCs and cultured cancer cells from whole blood using the CellSearch® system and examined various cytomorphological characteristics. In contrast with cultured cancer cells, CTCs enriched by CellSearch® system were found to have significantly smaller size, larger nuclear-cytoplasmic ratio, and more elongated shape. These CTCs were also found to exhibit significantly more variability than cultured cancer cells in nuclear-cytoplasmic ratio and shape profile.
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Affiliation(s)
- Sunyoung Park
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard R. Ang
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon P. Duffy
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Biology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Jenny Bazov
- Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Kim N. Chi
- Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
- Department of Urologic Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C. Black
- BC Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
- Department of Urologic Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hongshen Ma
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Urologic Science, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Krawczyk N, Banys M, Hartkopf A, Hagenbeck C, Melcher C, Fehm T. Circulating tumour cells in breast cancer. Ecancermedicalscience 2013; 7:352. [PMID: 24066018 PMCID: PMC3776645 DOI: 10.3332/ecancer.2013.352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 01/05/2023] Open
Abstract
Evaluation of isolated tumour cells in bone marrow (BM) and peripheral blood has become a major focus of translational cancer research. The presence of disseminated tumour cells in BM is a common phenomenon observed in 30–40% of primary breast cancer patients and independently predicts reduced clinical outcome. The detection of circulating tumour cells (CTCs) in blood might become a desired alternative to the invasive and painful BM biopsy. Recent clinical trials confirmed the feasibility of CTC detection as a robust and reproducible parameter for prognostication in both adjuvant and metastatic setting. The characterisation of CTCs might become an important biomarker for therapy monitoring and help to identify specific targets for novel therapeutic strategies.
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Affiliation(s)
- Natalia Krawczyk
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
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Martín M, Custodio S, de Las Casas MLM, García-Sáenz JÁ, de la Torre JC, Bellón-Cano JM, López-Tarruella S, Vidaurreta-Lazaro M, de la Orden V, Jerez Y, Márquez-Rodas I, Casado A, Sastre J, Díaz-Rubio E. Circulating tumor cells following first chemotherapy cycle: an early and strong predictor of outcome in patients with metastatic breast cancer. Oncologist 2013; 18:917-23. [PMID: 23873719 DOI: 10.1634/theoncologist.2012-0479] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We investigated the prognostic significance of circulating tumor cells (CTCs) determined immediately before the second cycle of chemotherapy in patients with metastatic breast cancer (MBC). The CTC counts were taken at baseline, before the first cycle of chemotherapy (CTC-0), and on day 21 before commencing the second cycle of chemotherapy (CTC-21) in consecutive MBC patients. The study's primary objectives were to analyze relationships between CTC-21 count and overall survival (OS). Based on the current literature, the CTC measurements were dichotomized as 0-4 versus ≥ 5 CTCs. Of 117 patients recruited, 99 were evaluable. Patients with 0-4 CTCs on day 21 had a significantly better OS than those with ≥ 5 CTCs (median OS: 38.5 months vs. 8.7 months). They also had a significantly better progression-free survival (PFS; median: 9.4 months vs. 3.0 months) and clinical benefit rate (77% vs. 44%). The OS of patients whose baseline CTCs were ≥ 5 but dropped to <5 on day 21 was apparently similar to those who had <5 CTCs at baseline. In a Cox regression analysis, CTC-21 was the only independent variable significantly predicting OS and PFS. Our data indicate that CTCs determined immediately before the second cycle of chemotherapy is an early and strong predictor of treatment outcome in MBC patients.
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Affiliation(s)
- Miguel Martín
- Medical Oncology Service, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain.
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Giordano A, Gao H, Cohen EN, Anfossi S, Khoury J, Hess K, Krishnamurthy S, Tin S, Cristofanilli M, Hortobagyi GN, Woodward WA, Lucci A, Reuben JM. Clinical relevance of cancer stem cells in bone marrow of early breast cancer patients. Ann Oncol 2013; 24:2515-2521. [PMID: 23798614 DOI: 10.1093/annonc/mdt223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cancer stem cells (CSCs) are epithelial tumor cells that express CD44(+)CD24(-/lo). CSCs can be further divided into those that have aldehyde dehydrogenase (ALDH) activity (Aldefluor(+)) and those that do not. We hypothesized that if CSCs are responsible for tumor dissemination, their presence in bone marrow (BM) would be prognostic in early stages of breast cancer (EBC) patients. PATIENTS AND METHODS BM aspirates were collected at the time of surgery from 108 patients with EBC. BM was analyzed for CSCs and ALDH activity by flow cytometry. Overall survival and disease-free survival (DFS) were calculated from the date of diagnosis and analyzed with Kaplan-Meier survival plots. Cox multivariate proportional hazards model was also carried out. RESULTS Patients with CSCs in BM had a hazard ratio (HR) of 8.8 for DFS (P = 0.002); patients with Aldefluor(+) CSCs had a HR of 5.9 (P = 0.052) for DFS. All deceased patients (n = 7) had CSCs in BM. In multivariate analysis, the presence of CSCs in BM was a prognostic factor of DFS (HR = 15.8, P = 0.017). CONCLUSIONS The presence of BM metastasis is correlated with CSCs and these CSCs irrespective of ALDH activity are an independent adverse prognostic factor in EBC patients.
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Affiliation(s)
- A Giordano
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Endocrinology and Molecular and Clinical Oncology, University of Naples Federico II, Naples, Italy
| | - H Gao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E N Cohen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Anfossi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Hess
- Departments of Biostatistics
| | - S Krishnamurthy
- Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - S Tin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Cristofanilli
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | | | | | - A Lucci
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J M Reuben
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Circulating tumor cells as predictors of response and failure in breast cancer patients treated with preoperative chemotherapy. Int J Biol Markers 2013; 28:17-23. [PMID: 23015398 DOI: 10.5301/jbm.2012.9580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 12/16/2022]
Abstract
AIM To explore the significance of circulating tumor cells (CTCs) detection in the course of preoperative chemotherapy (PC) and their effect on the outcomes.
METHODS Fifty-five patients with stage II/III invasive breast cancer were enrolled into a preoperative clinical trial. Patients were given PC with sequential single-agent doxorubicin and paclitaxel vs paclitaxel followed by doxorubicin. Blood samples (8 mL) were collected from patients before PC, after each phase, and at 6 months intervals during follow-up. Peripheral blood mononuclear cells were isolated and enriched for epithelial cells. Quantitative RT-PCR was used to determine the presence of cytokeratin 19 (CK19) mRNA. Samples were considered positive when the PCR curve crossed the standard threshold curve.
RESULTS After the first phase of chemotherapy, there was a 59% overall reduction in the median tumor volume. The percentage of volume reduction did not differ between patients who presented with detectable CTCs at baseline and those who did not (p=0.89). After the second phase of chemotherapy, there was a further decrease in the median tumor volume to 93% from baseline. There was no correlation between the lack of response and the presence of CTCs either after the first (p=0.36) or second (p=0.5391) phases of PC. The presence of CTCs was a predictor of local or distant relapse (p=0.0411). The detection of CTCs did not affect overall survival (p=0.2569).
CONCLUSION CTCs can be used as predictors of relapse after definitive treatment of locally advanced breast cancer; however, CTCs detection in peripheral blood during the course of PC does not implicate a particular pattern of response to treatment.
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Schindlbeck C, Andergassen U, Hofmann S, Jückstock J, Jeschke U, Sommer H, Friese K, Janni W, Rack B. Comparison of circulating tumor cells (CTC) in peripheral blood and disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients. J Cancer Res Clin Oncol 2013; 139:1055-62. [DOI: 10.1007/s00432-013-1418-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/06/2013] [Indexed: 11/28/2022]
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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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Disseminated tumour cells in the bone marrow in early breast cancer: morphological categories of immunocytochemically positive cells have different impact on clinical outcome. Breast Cancer Res Treat 2013; 138:485-97. [DOI: 10.1007/s10549-013-2439-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
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Yi Z, Li XY, Gao Q, Tang LJ, Chu X. Aptamer-aided target capturing with biocatalytic metal deposition: an electrochemical platform for sensitive detection of cancer cells. Analyst 2013; 138:2032-7. [PMID: 23420020 DOI: 10.1039/c3an36474g] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A novel aptamer biosensor for cancer cell assay has been reported on the basis of ultrasensitive electrochemical detection. Cancer cell capturing is first accomplished via aptamer-aided recognition, and the cell-aptamer binding events then mediate an alkaline phosphatase-catalyzed silver deposition reaction which can be probed by electrochemical detection. Following biocatalytic silver deposition, an efficient amplification approach for sensitive electrochemical measurements is demonstrated, for cell detection with high sensitivity. Ramos cell are used as a model case, a typical biomarker of the acute blood cell cancer, Burkitt's lymphoma. The results reveal that the developed technique displays desirable selectivity in Ramos cell discrimination, and linear response range from 10 to 10(6) cells with a detection limit as low as 10 cells. Due to the simple procedures, label-free and electrochemistry based detection format, this technique is simple and cost-effective, and exhibits excellent compatibility with miniaturization technologies. The electrochemical cell detection strategy may create an intrinsically specific and sensitive platform for cancer cell assay and associated studies.
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Affiliation(s)
- Zi Yi
- State Key Laboratory of Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, PR China
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Hartkopf AD, Taran FA, Wallwiener M, Hagenbeck C, Melcher C, Krawczyk N, Hahn M, Wallwiener D, Fehm T. The presence and prognostic impact of apoptotic and nonapoptotic disseminated tumor cells in the bone marrow of primary breast cancer patients after neoadjuvant chemotherapy. Breast Cancer Res 2013; 15:R94. [PMID: 24099325 PMCID: PMC3978634 DOI: 10.1186/bcr3496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/27/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neoadjuvant systemic therapy of primary breast cancer (PBC) patients offers the possibility to monitor treatment response. However, patients might have metastatic relapse despite achieving a pathologic complete response (pCR). This indicates that local response to therapy must not be representative for systemic treatment efficacy. Therefore, the aim of this study was to compare local response with systemic tumor cell dissemination by determining the presence of disseminated tumor cells (DTCs), including apoptotic tumor cells, in the bone marrow (BM) of PBC patients after neoadjuvant chemotherapy (NACT). METHODS DTCs were detected by immunocytochemistry (pancytokeratin antibody A45-B/B3) and cytomorphology (DTC status). The presence of apoptotic tumor cells was determined by using the M30 antibody (M30 status). This antibody detects a neo-epitope that is expressed only during early apoptosis. RESULTS BM aspirates from 400 PBC patients that had completed NACT were eligible for this study. Of these, 167 (42%) patients were DTC positive (DTC status). The M30 status was investigated in 308 patients. Apoptotic (M30-positive) tumor cells were detected in 89 (29%) of these. Whereas the DTC status was not correlated (P = 0.557) to local treatment response (that is, pCR or a clinical complete/partial response), the presence of M30-positive tumor cells was significantly higher in patients that responded to therapy (P = 0.026). Additionally, DTC-positive patients were at an increased risk for disease relapse (hazard ratio, 1.87; 95% CI, 1.11 to 3.15; P = 0.019). CONCLUSION The presence of DTC is independent of therapy response of the primary tumor. As patients that are DTC positive after NACT have an unfavorable outcome, they might benefit from additional systemic treatment.
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Affiliation(s)
- Andreas Daniel Hartkopf
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany
| | - Carsten Hagenbeck
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Carola Melcher
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Markus Hahn
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
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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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Zhao S, Yang H, Zhang M, Zhang D, Liu Y, Liu Y, Song Y, Zhang X, Li H, Ma W, Zhang Q. Circulating Tumor Cells (CTCs) Detected by Triple-Marker EpCAM, CK19, and hMAM RT-PCR and Their Relation to Clinical Outcome in Metastatic Breast Cancer Patients. Cell Biochem Biophys 2012; 65:263-73. [DOI: 10.1007/s12013-012-9426-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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