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Esapa B, Jiang J, Cheung A, Chenoweth A, Thurston DE, Karagiannis SN. Target Antigen Attributes and Their Contributions to Clinically Approved Antibody-Drug Conjugates (ADCs) in Haematopoietic and Solid Cancers. Cancers (Basel) 2023; 15:1845. [PMID: 36980732 PMCID: PMC10046624 DOI: 10.3390/cancers15061845] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
Antibody drug conjugates (ADCs) are powerful anti-cancer therapies comprising an antibody joined to a cytotoxic payload through a chemical linker. ADCs exploit the specificity of antibodies for their target antigens, combined with the potency of cytotoxic drugs, to selectively kill target antigen-expressing tumour cells. The recent rapid advancement of the ADC field has so far yielded twelve and eight ADCs approved by the US and EU regulatory bodies, respectively. These serve as effective targeted treatments for several haematological and solid tumour types. In the development of an ADC, the judicious choice of an antibody target antigen with high expression on malignant cells but restricted expression on normal tissues and immune cells is considered crucial to achieve selectivity and potency while minimising on-target off-tumour toxicities. Aside from this paradigm, the selection of an antigen for an ADC requires consideration of several factors relating to the expression pattern and biological features of the target antigen. In this review, we discuss the attributes of antigens selected as targets for antibodies used in clinically approved ADCs for the treatment of haematological and solid malignancies. We discuss target expression, functions, and cellular kinetics, and we consider how these factors might contribute to ADC efficacy.
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Affiliation(s)
- Benjamina Esapa
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Jiexuan Jiang
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Anthony Cheung
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London SE1 9RT, UK
| | - Alicia Chenoweth
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London SE1 9RT, UK
| | - David E. Thurston
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9NH, UK
| | - Sophia N. Karagiannis
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London SE1 9RT, UK
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2
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Fu Y, Bian X, Li P, Huang Y, Li C. Carrier-Free Nanomedicine for Cancer Immunotherapy. J Biomed Nanotechnol 2022; 18:939-956. [PMID: 35854464 DOI: 10.1166/jbn.2022.3315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
With the rapid development of nanotechnology, carrier-based nano-drug delivery systems (DDSs) have been widely studied due to their advantages in optimizing pharmacokinetic and distribution profiles. However, despite those merits, some carrier-related limitations, such as low drug-loading capacity, systematic toxicity and unclear metabolism, usually prevent their further clinical transformation. Carrier-free nanomedicines with non-therapeutic excipients, are considered as an excellent paradigm to overcome these obstacles, owing to their superiority in improving both drug delivery efficacy and safety concern. In recent years, carrier-free nanomedicines have opened new horizons for cancer immunotherapy, and have already made outstanding progress. Herein, in this review, we are focusing on making an integrated and exhaustive overview of lately reports about them. Firstly, the major synthetic strategies of carrier-free nanomedicines are introduced, such as nanocrystals, prodrug-, amphiphilic drug-drug conjugates (ADDCs)-, polymer-drug conjugates-, and peptide-drug conjugates (PepDCs)-assembled nanomedicines. Afterwards, the typical applications of carrier-free nanomedicines in cancer immunotherapy are well-discussed, including cancer vaccines, cytokine therapy, enhancing T-cell checkpoint inhibition, as well as modulating tumor microenvironment (TME). After that, both the advantages and the potential challenges, as well as the future prospects of carrier-free nanomedicines in cancer immunotherapy, were discussed. And we believe that it would be of great potential practiced and reference value to the relative fields.
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Affiliation(s)
- Yu Fu
- Medical Research Institute, College of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, China
| | - Xufei Bian
- Medical Research Institute, College of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, China
| | - Pingrong Li
- Medical Research Institute, College of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, China
| | - Yulan Huang
- Medical Research Institute, College of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, China
| | - Chong Li
- Medical Research Institute, College of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, China
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3
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Smet A, Breugelmans T, Michiels J, Lamote K, Arras W, De Man JG, Heyndrickx L, Hauner A, Huizing M, Malhotra-Kumar S, Lammens M, Hotterbeekx A, Kumar-Singh S, Verstraeten A, Loeys B, Verhoeven V, Jacobs R, Dams K, Coenen S, Ariën KK, Jorens PG, De Winter BY. A dynamic mucin mRNA signature associates with COVID-19 disease presentation and severity. JCI Insight 2021; 6:e151777. [PMID: 34448730 PMCID: PMC8525642 DOI: 10.1172/jci.insight.151777] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/25/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection induces mucin overexpression, further promoting disease. Given that mucins are critical components of innate immunity, unraveling their expression profiles that dictate the course of disease could greatly enhance our understanding and management of COVID-19. METHODS Using validated RT-PCR assays, we assessed mucin mRNA expression in the blood of patients with symptomatic COVID-19 compared with symptomatic patients without COVID-19 and healthy controls and correlated the data with clinical outcome parameters. Additionally, we analyzed mucin expression in mucus and lung tissue from patients with COVID-19 and investigated the effect of drugs for COVID-19 treatment on SARS-CoV-2–induced mucin expression in pulmonary epithelial cells. RESULTS We identified a dynamic blood mucin mRNA signature that clearly distinguished patients with symptomatic COVID-19 from patients without COVID-19 based on expression of MUC1, MUC2, MUC4, MUC6, MUC13, MUC16, and MUC20 (AUCROC of 91.8%; sensitivity and specificity of 90.6% and 93.3%, respectively) and that discriminated between mild and critical COVID-19 based on the expression of MUC16, MUC20, and MUC21 (AUCROC of 89.1%; sensitivity and specificity of 90.0% and 85.7%, respectively). Differences in the transcriptional landscape of mucins in critical cases compared with mild cases identified associations with COVID-19 symptoms, respiratory support, organ failure, secondary infections, and mortality. Furthermore, we identified different mucins in the mucus and lung tissue of critically ill COVID-19 patients and showed the ability of baricitinib, tocilizumab, favipiravir, and remdesivir to suppress expression of SARS-CoV-2–induced mucins. CONCLUSION This multifaceted blood mucin mRNA signature showed the potential role of mucin profiling in diagnosing, estimating severity, and guiding treatment options in patients with COVID-19. FUNDING The Antwerp University Research and the Research Foundation Flanders COVID-19 funds.
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Affiliation(s)
- Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Tom Breugelmans
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Johan Michiels
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Kevin Lamote
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Wout Arras
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Joris G De Man
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Leo Heyndrickx
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Anne Hauner
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Manon Huizing
- Biobank Antwerpen, Antwerp University Hospital, Edegem, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Martin Lammens
- Department of Histopathology, Antwerp University Hospital, Edegem, Belgium
| | - An Hotterbeekx
- Laboratory of Cell Biology and Histology, Molecular Pathology Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Samir Kumar-Singh
- Laboratory of Cell Biology and Histology, Molecular Pathology Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Aline Verstraeten
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Bart Loeys
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rita Jacobs
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Karolien Dams
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kevin K Ariën
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe G Jorens
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Division of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
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4
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Brouwer A, De Laere B, van Dam PJ, Peeters D, Van Haver J, Sluydts E, El Moussaoui A, Mendelaar P, Kraan J, Peeters M, Van Laere S, Dirix L. HER-2 status of circulating tumor cells in a metastatic breast cancer cohort: A comparative study on characterization techniques. PLoS One 2019; 14:e0220906. [PMID: 31483799 PMCID: PMC6726188 DOI: 10.1371/journal.pone.0220906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/25/2019] [Indexed: 12/20/2022] Open
Abstract
Background Personalized targeted treatment in metastatic breast cancer relies on accurate assessment of molecular aberrations, e.g. overexpression of Human Epidermal growth factor Receptor 2 (HER-2). Molecular interrogation of circulating tumor cells (CTCs) can provide an attractive alternative for real-time biomarker assessment. However, implementation of CellSearch-based HER-2 analysis has been limited. Immunofluorescent (IF) image interpretation is crucial, as different HER-2 categories have been described. Major questions in CTC research are how these IF categories reflect gene expression and amplification, and if we should consider ‘medium’ HER-2 expressing CTCs for patient selection. Methods Tumor cells from spiked cell lines (n = 8) and CTCs (n = 116 samples) of 85 metastatic breast cancer patients were enriched using CellSearch. Comparative analysis of HER-2 expression by IF imaging (ACCEPT, DEPArray, and visual scoring) with qRT-PCR and HER-2/neu FISH was performed. Results Automated IF HER-2-profiling by DEPArray and ACCEPT delivered comparable results. There was a 98% agreement between 17 trained observers (visual scoring) and ACCEPT considering HER-2neg and HER-2high expressing CTCs. However, 89% of HER-2med expressing CTCs by ACCEPT were scored negative by observers. HER-2high expressing tumor cells demonstrated HER-2/neu gene amplification, whereas HER-2neg and HER-2med expressing tumor cells and CTCs by ACCEPT were copy-number neutral. All patients with HER-2-positive archival tumors had ≥1 HER-2high expressing CTCs, while 80% of HER-2-negative patients did not. High relative gene expression of HER-2 measured on enriched CTC lysates correlated with having ≥1 HER-2high expressing CTCs. Conclusion Automated images analysis has enormous potential for clinical implementation. HER-2 characterization and clinical trial design should be focused on HER-2high expressing CTCs.
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Affiliation(s)
- Anja Brouwer
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
- Department of Oncology, Antwerp University Hospital, Antwerp, Belgium
- * E-mail:
| | - Bram De Laere
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pieter-Jan van Dam
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
- HistoGeneX NV, Wilrijk, Antwerp, Belgium
| | - Dieter Peeters
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
- HistoGeneX NV, Wilrijk, Antwerp, Belgium
| | - Jasper Van Haver
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | | | | | - Pauline Mendelaar
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jaco Kraan
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marc Peeters
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
- Department of Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Steven Van Laere
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Luc Dirix
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
- Department of Oncology, GZA Hospitals Sint-Augustinus, Antwerp, Belgium
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5
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Gallo M, De Luca A, Frezzetti D, Passaro V, Maiello MR, Normanno N. The potential of monitoring treatment response in non-small cell lung cancer using circulating tumour cells. Expert Rev Mol Diagn 2019; 19:683-694. [PMID: 31305173 DOI: 10.1080/14737159.2019.1640606] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Circulating tumor cell (CTC) counts represent an attractive strategy for monitoring response to therapy in patients with advanced non-small cell lung cancer (NSCLC). Changes in the CTCs number during the treatment have been proposed as a predictive biomarker of response to both chemotherapy and targeted therapies. Profiling of CTCs might also allow the assessment of the dynamics of predictive biomarkers such as EGFR, ALK, ROS1, and PD-L1, and provide relevant information in patients progressing on treatment with targeted agents including immunotherapeutics. Areas covered: A search of peer-reviewed literature in bibliographic databases was undertaken to discuss studies on CTCs and their predictive role in NSCLC. Expert opinion: To date, some challenges limit the clinical utility of CTCs in monitoring the response to treatment in NSCLC. The standardization of techniques for CTCs isolation and characterization and their validation on larger cohorts of patients might help to translate CTCs analysis in the clinic. However, studies on CTCs can provide information on molecular mechanisms involved in NSCLC progression and in the acquired resistance to treatments.
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Affiliation(s)
- Marianna Gallo
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale" , Naples , Italy
| | - Antonella De Luca
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale" , Naples , Italy
| | - Daniela Frezzetti
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale" , Naples , Italy
| | - Valeria Passaro
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale" , Naples , Italy
| | - Monica R Maiello
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale" , Naples , Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale" , Naples , Italy
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Chen Y, Zou TN, Wu ZP, Zhou YC, Gu YL, Liu X, Jin CG, Wang XC. Detection of Cytokeratin 19, Human Mammaglobin, and Carcinoembryonic Antigen-Positive Circulating Tumor Cells by Three-Marker Reverse Transcription-Pcr Assay and Its Relation to Clinical Outcome in Early Breast Cancer. Int J Biol Markers 2018; 25:59-68. [DOI: 10.1177/172460081002500201] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims To investigate the diagnostic, predictive, and prognostic value of the detection of circulating tumor cells (CTCs) using a three-marker (CK19, hMAM and CEA) RT-PCR assay in patients with early breast cancer. Patients and methods Peripheral blood was obtained from 50 patients with early-stage breast cancer before any systemic adjuvant therapy and analyzed for the presence of CK-19, hMAM and CEA mRNA-positive CTCs using an RT-PCR assay. The specificity of the primers used was evaluated in 20 healthy individuals, 24 patients with benign breast disease, and 30 patients with metastatic breast cancer. The detection of CTCs was correlated with clinical outcome. Results The detection rate of three-marker-positive CTCs in the blood of patients with early breast cancer was 54.0%, significantly higher than in patients with benign breast disease and healthy blood donors (p=0.002 and p=0.000, respectively). The three-marker RT-PCR assay had 58.8% sensitivity in the parallel test and 100% specificity for CTC detection in the serial test, which was higher than the sensitivity and specificity of single-marker assays. For early breast cancer, correlation analysis between detection of three-marker-positive CTCs and clinicopathological characteristics indicated that detection of three-marker-positive CTCs was significantly correlated with elevated serum CEA levels (p=0.001). After three years of follow-up, 13 of the 27 patients with three-marker-positive CTCs in their blood had relapsed and detection of three-marker-positive CTCs was significantly associated with locoregional recurrence and/or distant metastasis (p=0.002). Detection of three-marker-positive CTCs in peripheral blood was an independent risk factor for reduced median relapse-free interval (p=0.000). Conclusion The three-marker RT-PCR assay can enhance the sensitivity and specificity of CTC detection compared to single-marker assay. Detection of three-marker-positive CTCs was associated with relapse and might have important predictive and prognostic implications in early breast cancer.
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Affiliation(s)
- Yan Chen
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Tian Ning Zou
- Department of Breast Cancer, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Zhi Ping Wu
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Yong Chun Zhou
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Yu Lan Gu
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Xin Liu
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Cong Guo Jin
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
| | - Xi Cai Wang
- Yunnan Tumor Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming - China
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7
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Nunes RA, Li X, Kang SP, Burstein H, Roberts L, Carney W, Blackwell K, Ryan P, Borges V, Iglehart JD, Friedman P, Harris LN. Circulating Tumor Cells in HER-2 Positive Metastatic Breast Cancer Patients Treated with Trastuzumab and Chemotherapy. Int J Biol Markers 2018; 24:1-10. [DOI: 10.1177/172460080902400101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The detection of circulating tumor cells (CTCs) in peripheral blood may have important prognostic and predictive implications in breast cancer treatment. A limitation in this field has been the lack of a validated method of accurately measuring CTCs. While sensitivity has improved using RT-PCR, specificity remains a major challenge. The goal of this paper is to present a sensitive and specific methodology of detecting CTCs in women with HER-2-positive metastatic breast cancer, and to examine its role as a marker that tracks disease response during treatment with trastuzumab-containing regimens. The study included patients with HER-2-positive metastatic breast cancer enrolled on two different clinical protocols using a trastuzumab-containing regimen. Serial CTCs were measured at planned time points and clinical correlations were made. Immunomagnetic selection of circulating epithelial cells was used to address the specificity of tumor cell detection using cytokeratin 19 (CK19). In addition, the extracellular domain of the HER-2 protein (HER-2/ECD) was measured to determine if CTCs detected by CK19 accurately reflect tumor burden. The presence of CTCs at first restaging was associated with disease progression. We observed an association between CK19 and HER-2/ECD. The association of HER-2/ECD with clinical response followed a similar pattern to that seen with CK19. Finally, the absence of HER-2/ECD at best overall response and a change of HER-2/ECD from positive at baseline to negative at best overall response was associated with favorable treatment response. Our study supports the prognostic and predictive role of the detection of CTCs in treatment of HER-2-positive metastatic breast cancer patients. The association between CK19 and markers of disease burden is in line with the concept that CTCs may be a reliable measure of tumor cells in the peripheral blood of patients with metastatic breast cancer. The association of CTCs at first restaging with treatment failure indicates that CTCs may have a role as surrogate markers to monitor treatment response.
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Affiliation(s)
- Raquel A. Nunes
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xiaochun Li
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Soonmo Peter Kang
- Section of Medical Oncology, Yale University School of Medicine/Yale Cancer Center, New Haven, CT - USA
| | - Harold Burstein
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Walter Carney
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kimberly Blackwell
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Paula Ryan
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Virginia Borges
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - J. Dirk Iglehart
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Lyndsay N. Harris
- Section of Medical Oncology, Yale University School of Medicine/Yale Cancer Center, New Haven, CT - USA
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8
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Zhang X, Hofmann S, Rack B, Harbeck N, Jeschke U, Sixou S. Fluorescence Analysis of Vitamin D Receptor Status of Circulating Tumor Cells (CTCS) in Breast Cancer: From Cell Models to Metastatic Patients. Int J Mol Sci 2017. [PMID: 28632174 PMCID: PMC5486139 DOI: 10.3390/ijms18061318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Vitamin D receptor (VDR) expressed in normal breast tissue and breast tumors has been suggested as a new prognostic biomarker in breast cancer (BC). Besides, increasing evidence supports the view that the detection of circulating tumor cells (CTCs) predicts outcome in early and metastatic BC. Consequently, an evaluation of VDR expression in the CTCs of BC patients may allow optimization of their treatment. As an attempt to profile and subtype the CTCs of metastatic patients, we established an innovative fluorescence technique using nine BC cell lines to visualize, define, and compare their individual VDR status. Afterwards, we tested the CTC presence and VDR expression in blood samples (cytospins) collected from 23 metastatic BC patients. The results demonstrated major differences in the VDR levels among the nine cell lines, and VDR positive CTCs were detected in 46% of CTC-positive patients, with a total of 42 CTCs individually analyzed. Due to the limited number of patients in this study, no correlation between VDR expression and BC subtype classification (according to estrogen receptor (ER), progesterone receptor (PR) and HER2) could be determined, but our data support the view that VDR evaluation is a potential new prognostic biomarker to help in the optimization of therapy management for BC patients.
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Affiliation(s)
- Xi Zhang
- Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians University of Munich (LMU), Maistrasse 11, Munich 80337, Germany.
| | - Simone Hofmann
- Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians University of Munich (LMU), Maistrasse 11, Munich 80337, Germany.
| | - Brigitte Rack
- Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians University of Munich (LMU), Maistrasse 11, Munich 80337, Germany.
| | - Nadia Harbeck
- Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians University of Munich (LMU), Maistrasse 11, Munich 80337, Germany.
| | - Udo Jeschke
- Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians University of Munich (LMU), Maistrasse 11, Munich 80337, Germany.
| | - Sophie Sixou
- Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians University of Munich (LMU), Maistrasse 11, Munich 80337, Germany.
- Faculty of Pharmacy, University Paul Sabatier Toulouse III, Toulouse cedex 09 31062, France.
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9
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Pedrol E, Garcia-Algar M, Massons J, Nazarenus M, Guerrini L, Martínez J, Rodenas A, Fernandez-Carrascal A, Aguiló M, Estevez LG, Calvo I, Olano-Daza A, Garcia-Rico E, Díaz F, Alvarez-Puebla RA. Optofluidic device for the quantification of circulating tumor cells in breast cancer. Sci Rep 2017. [PMID: 28623262 PMCID: PMC5473916 DOI: 10.1038/s41598-017-04033-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Metastatic cancer patients require a continuous monitoring during the sequential treatment cycles to carefully evaluate their disease evolution. Repetition of biopsies is very invasive and not always feasible. Herein, we design and demonstrate a 3D-flow focusing microfluidic device, where all optics are integrated into the chip, for the fluorescence quantification of CTCs in real samples. To test the chip performance, two cell membrane targets, the epithelial cell adhesion molecule, EpCAM, and the receptor tyrosine-protein kinase, HER2, are selected. The efficiency of the platform is demonstrated on cell lines and in a variety of healthy donors and metastatic-breast cancer patients.
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Affiliation(s)
- Eric Pedrol
- Física i Cristal•lografia de Materials i Nanomaterials and EmaS. Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Manuel Garcia-Algar
- Departamento de Química Física e Inorgánica and EmaS, Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Jaume Massons
- Física i Cristal•lografia de Materials i Nanomaterials and EmaS. Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Moritz Nazarenus
- Departamento de Química Física e Inorgánica and EmaS, Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Luca Guerrini
- Departamento de Química Física e Inorgánica and EmaS, Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Javier Martínez
- Física i Cristal•lografia de Materials i Nanomaterials and EmaS. Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Airan Rodenas
- Física i Cristal•lografia de Materials i Nanomaterials and EmaS. Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Ana Fernandez-Carrascal
- Departamento de Química Física e Inorgánica and EmaS, Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Magdalena Aguiló
- Física i Cristal•lografia de Materials i Nanomaterials and EmaS. Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain
| | - Laura G Estevez
- Fundacion de Investigacion HM Hospitales, San Bernardo 101, 28015, Madrid, Spain.,Centro Integral Oncologico Clara Campal (CIOCC), Oña 10, 28050, Madrid, Spain
| | - Isabel Calvo
- Fundacion de Investigacion HM Hospitales, San Bernardo 101, 28015, Madrid, Spain.,Centro Integral Oncologico Clara Campal (CIOCC), Oña 10, 28050, Madrid, Spain
| | - Ana Olano-Daza
- Department of Medical Oncology, Hospital Universitario HM Torrelodones, Castillo de Olivares s/n, 28250, Torrelodones, Spain
| | - Eduardo Garcia-Rico
- Fundacion de Investigacion HM Hospitales, San Bernardo 101, 28015, Madrid, Spain. .,Centro Integral Oncologico Clara Campal (CIOCC), Oña 10, 28050, Madrid, Spain. .,Department of Medical Oncology, Hospital Universitario HM Torrelodones, Castillo de Olivares s/n, 28250, Torrelodones, Spain. .,School of Medicine, San Pablo CEU, Calle Julián Romea, 18, 28003, Madrid, Spain.
| | - Francesc Díaz
- Física i Cristal•lografia de Materials i Nanomaterials and EmaS. Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain.
| | - Ramon A Alvarez-Puebla
- Departamento de Química Física e Inorgánica and EmaS, Universitat Rovira i Virgili, Carrer Marcel•lí Domingo 1, 43007, Tarragona, Spain. .,ICREA, Passeig Lluís Companys 23, 08010, Barcelona, Spain.
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10
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Park MH, Reátegui E, Li W, Tessier SN, Wong KHK, Jensen AE, Thapar V, Ting D, Toner M, Stott SL, Hammond PT. Enhanced Isolation and Release of Circulating Tumor Cells Using Nanoparticle Binding and Ligand Exchange in a Microfluidic Chip. J Am Chem Soc 2017; 139:2741-2749. [PMID: 28133963 DOI: 10.1021/jacs.6b12236] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The detection of rare circulating tumor cells (CTCs) in the blood of cancer patients has the potential to be a powerful and noninvasive method for examining metastasis, evaluating prognosis, assessing tumor sensitivity to drugs, and monitoring therapeutic outcomes. In this study, we have developed an efficient strategy to isolate CTCs from the blood of breast cancer patients using a microfluidic immune-affinity approach. Additionally, to gain further access to these rare cells for downstream characterization, our strategy allows for easy detachment of the captured CTCs from the substrate without compromising cell viability or the ability to employ next generation RNA sequencing for the identification of specific breast cancer genes. To achieve this, a chemical ligand-exchange reaction was engineered to release cells attached to a gold nanoparticle coating bound to the surface of a herringbone microfluidic chip (NP-HBCTC-Chip). Compared to the use of the unmodified HBCTC-Chip, our approach provides several advantages, including enhanced capture efficiency and recovery of isolated CTCs.
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Affiliation(s)
- Myoung-Hwan Park
- Department of Chemistry, Sahmyook University , Seoul, 01795, Korea
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11
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Dempsey PW. CTCs and ctDNA: Two Tales of a Complex Biology. LIQUID BIOPSIES IN SOLID TUMORS 2017. [DOI: 10.1007/978-3-319-50956-3_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Kuniyoshi RK, Gehrke FDS, Alves BCA, Vilas-Bôas V, Coló AE, Sousa N, Nunes J, Fonseca FLA, Del Giglio A. Gene profiling and circulating tumor cells as biomarker to prognostic of patients with locoregional breast cancer. Tumour Biol 2015; 36:8075-83. [PMID: 25976504 DOI: 10.1007/s13277-015-3529-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/04/2015] [Indexed: 01/03/2023] Open
Abstract
The gene profile of primary tumors, as well as the identification of circulating tumor cells (CTCs), can provide important prognostic and predictive information. In this study, our objective was to perform tumor gene profiling (TGP) in combination with CTC characterization in women with nonmetastatic breast cancer. Biological samples (from peripheral blood and tumors) from 167 patients diagnosed with stage I, II, and III mammary carcinoma, who were also referred for adjuvant/neoadjuvant chemotherapy, were assessed for the following parameters: (a) the presence of CTCs identified by the expression of CK-19 and c-erbB-2 in the peripheral blood mononuclear cell (PBMC) fraction by quantitative reverse transcription PCR (RT-PCR) and (b) the TGP, which was determined by analyzing the expression of 21 genes in paraffin-embedded tissue samples by quantitative multiplex RT-PCR with the Plexor® system. We observed a statistically significant correlation between the progression-free interval (PFI) and the clinical stage (p = 0.000701), the TGP score (p = 0.006538), and the presence of hormone receptors in the tumor (p = 0.0432). We observed no correlation between the PFI and the presence or absence of CK-19 or HER2 expression in the PBMC fraction prior to the start of treatment or in the two following readouts. Multivariate analysis revealed that only the TGP score significantly correlated with the PFI (p = 0.029247). The TGP is an important prognostic variable for patients with locoregional breast cancer. The presence of CTCs adds no prognostic value to the information already provided by the TGP.
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Affiliation(s)
- Renata K Kuniyoshi
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Flávia de Sousa Gehrke
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Beatriz C A Alves
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Viviane Vilas-Bôas
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Anna E Coló
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
| | - Naiara Sousa
- Fundação Pio XII-Hospital de Câncer de Barretos, R. Antenor Duarte Vilela, 1331, Barretos, SP, Brazil.
| | - João Nunes
- Fundação Pio XII-Hospital de Câncer de Barretos, R. Antenor Duarte Vilela, 1331, Barretos, SP, Brazil.
| | - Fernando L A Fonseca
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
- Biological Sciences Department, Federal University of São Paulo, R. Prof. Arthur Riedel, 275, CEP 09972-270, Diadema, SP, Brazil.
| | - Auro Del Giglio
- Oncology and Hematology Department, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brazil.
- , Rua Mariana Correia 369, 01444-000, São Paulo, Capital, Brazil.
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13
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Winer-Jones JP, Vahidi B, Arquilevich N, Fang C, Ferguson S, Harkins D, Hill C, Klem E, Pagano PC, Peasley C, Romero J, Shartle R, Vasko RC, Strauss WM, Dempsey PW. Circulating tumor cells: clinically relevant molecular access based on a novel CTC flow cell. PLoS One 2014; 9:e86717. [PMID: 24489774 PMCID: PMC3906064 DOI: 10.1371/journal.pone.0086717] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/11/2013] [Indexed: 02/05/2023] Open
Abstract
Background Contemporary cancer diagnostics are becoming increasing reliant upon sophisticated new molecular methods for analyzing genetic information. Limiting the scope of these new technologies is the lack of adequate solid tumor tissue samples. Patients may present with tumors that are not accessible to biopsy or adequate for longitudinal monitoring. One attractive alternate source is cancer cells in the peripheral blood. These rare circulating tumor cells (CTC) require enrichment and isolation before molecular analysis can be performed. Current CTC platforms lack either the throughput or reliability to use in a clinical setting or they provide CTC samples at purities that restrict molecular access by limiting the molecular tools available. Methodology/Principal Findings Recent advances in magetophoresis and microfluidics have been employed to produce an automated platform called LiquidBiopsy®. This platform uses high throughput sheath flow microfluidics for the positive selection of CTC populations. Furthermore the platform quantitatively isolates cells useful for molecular methods such as detection of mutations. CTC recovery was characterized and validated with an accuracy (<20% error) and a precision (CV<25%) down to at least 9 CTC/ml. Using anti-EpCAM antibodies as the capture agent, the platform recovers 78% of MCF7 cells within the linear range. Non specific recovery of background cells is independent of target cell density and averages 55 cells/mL. 10% purity can be achieved with as low as 6 CTCs/mL and better than 1% purity can be achieved with 1 CTC/mL. Conclusions/Significance The LiquidBiopsy platform is an automated validated platform that provides high throughput molecular access to the CTC population. It can be validated and integrated into the lab flow enabling CTC enumeration as well as recovery of consistently high purity samples for molecular analysis such as quantitative PCR and Next Generation Sequencing. This tool opens the way for clinically relevant genetic profiling of CTCs.
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Affiliation(s)
- Jessamine P. Winer-Jones
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
- * E-mail:
| | - Behrad Vahidi
- Engineering, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Norma Arquilevich
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Cong Fang
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Samuel Ferguson
- Engineering, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Darren Harkins
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Cory Hill
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Erich Klem
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Paul C. Pagano
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Chrissy Peasley
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Juan Romero
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Robert Shartle
- Engineering, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Robert C. Vasko
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - William M. Strauss
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
| | - Paul W. Dempsey
- Research and Development, Cynvenio Biosystems, Westlake Village, California, United States of America
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Yamashita EK, Teixeira BM, Yoshihara RN, Kuniyoshi RK, Alves BCA, Gehrke FS, Vilas-Bôas VA, Correia JA, Azzalis LA, Junqueira VBC, Pereira EC, Fonseca FLA. Systemic chemotherapy interferes in homocysteine metabolism in breast cancer patients. J Clin Lab Anal 2014; 28:157-62. [PMID: 24395112 DOI: 10.1002/jcla.21660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/24/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hyperhomocysteinemia in breast cancer (BC) patients can be a risk factor for thromboembolic events. This study aimed to evaluate homocysteine and its cofators (folic acid and vitamin B12) concentrations and platelet count at diagnosis of BC, 3 and 6 months after the beginning of chemotherapy treatment and to correlate them with clinical data. METHODS Thirty-five BC patients were included; blood samples were obtained by venipuncture. Plasmatic Hcy and cofactors concentrations were measured by competitive chemiluminescent enzyme immunoassay method. Platelet count was done using an automated analyzer. Statistical analysis was performed using the software SPSS. RESULTS During chemotherapy, homocysteine (P = 0.032) and vitamin B12 (P < 0.001) concentrations increased, while folate and platelets decreased (P < 0.001). Among the clinical data, the menopausal status showed significant positive correlation (P = 0.022) with homocysteine concentration increase. CONCLUSIONS Evaluation of homocysteine concentrations during chemotherapy is extremely important because their levels increase during chemotherapy treatment, thus increasing the risk of thromboembolism development.
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Affiliation(s)
- Eliana K Yamashita
- Oncology and Hematology Department, ABC Medical School, Santo André, SP, Brazil
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15
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Magbanua MJM, Melisko M, Roy R, Sosa EV, Hauranieh L, Kablanian A, Eisenbud LE, Ryazantsev A, Au A, Scott JH, Park JW. Molecular profiling of tumor cells in cerebrospinal fluid and matched primary tumors from metastatic breast cancer patients with leptomeningeal carcinomatosis. Cancer Res 2013; 73:7134-43. [PMID: 24142343 DOI: 10.1158/0008-5472.can-13-2051] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although leptomeningeal carcinomatosis is a well-established clinical syndrome, virtually nothing is known about the tumor cells responsible for this particularly aggressive metastatic process. To isolate cerebrospinal fluid-derived tumor cells (CSFTC) from 15 patients with metastatic breast cancer diagnosed with leptomeningeal carcinomatosis, CSF samples were subjected to a two-step method involving immunomagnetic enrichment and fluorescence-activated cell sorting (IE/FACS), a technique previously used for isolating circulating tumor cells (CTC) from blood. CSFTCs were subjected to genome-wide copy number analysis by array comparative genomic hybridization. Genomic profiling was successfully performed for 13 of 15 patients (87%). Copy number analysis in CSFTCs revealed genomic alterations commonly observed in primary breast cancer and CTCs, indicating their malignant origin. Interestingly, 12 (92%) harbored high-level gains on the 8q24 locus, which includes the MYC oncogene. Comparison of CSFTCs against corresponding archival primary tumors in six patients revealed clonal relationships with some divergence. Good concordance among serial samples attested to the reproducibility of the assay. Our approach for isolation and molecular analysis of CSFTCs yielded new insights into the molecular nature of these cells. Further genomic and functional analyses may help elucidate mechanisms by which tumor cells metastasize to the central nervous system.
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Affiliation(s)
- Mark Jesus M Magbanua
- Authors' Affiliations: Division of Hematology/Oncology; Helen Diller Family Comprehensive Cancer Center; and Helen Diller Family Comprehensive Cancer Center Computational Biology Core, University of California San Francisco, San Francisco, California
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16
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Lasa A, Garcia A, Alonso C, Millet P, Cornet M, Ramón y Cajal T, Baiget M, Barnadas A. Molecular detection of peripheral blood breast cancer mRNA transcripts as a surrogate biomarker for circulating tumor cells. PLoS One 2013; 8:e74079. [PMID: 24058517 PMCID: PMC3776801 DOI: 10.1371/journal.pone.0074079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/26/2013] [Indexed: 01/11/2023] Open
Abstract
Circulating tumor cells (CTCs) are becoming a scientifically recognized indicator of primary tumors and/or metastasis. These cells can now be accurately detected and characterized as the result of technological advances. We analyzed the presence of CTCs in the peripheral blood of patients with metastatic breast cancer by real-time reverse-transcription PCR (RT-qPCR) using a panel of selected genes. The analysis of a single marker, without an EpCAM based enrichment approach, allowed the positive identification of 35% of the metastatic breast cancer patients. The analysis of five genes (SCGB2, TFF1, TFF3, Muc1, KRT20) performed in all the samples increased the detection to 61%. We describe a sensitive, reproducible and easy to implement approach to characterize CTC in patients with metastasic breast cancer.
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Affiliation(s)
- Adriana Lasa
- Genetics Department, Hospital de la Santa Creu i Sant Pau and CIBERER U705, Barcelona, Spain
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17
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Katseli A, Maragos H, Nezos A, Syrigos K, Koutsilieris M. Multiplex PCR-based detection of circulating tumor cells in lung cancer patients using CK19, PTHrP, and LUNX specific primers. Clin Lung Cancer 2013; 14:513-20. [PMID: 23810363 DOI: 10.1016/j.cllc.2013.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/13/2013] [Accepted: 04/16/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to develop a multiplex polymerase chain reaction (PCR)-based method for detection of circulating tumor cells in peripheral blood of lung cancer (LC) patients. PATIENTS AND METHODS Peripheral blood was collected from 71 healthy donors and 125 LC patients at different pathological stages. Samples were analyzed using multiplex PCR, and specific primers for CK19, PTHrP, and LUNX mRNA. The sensitivity of our method was set at 10 LC cells (A549 cells) in 3 mL of peripheral blood of healthy donors using spiking experiments. RESULTS The detection rates in LC patients for CK19, PTHrP, and LUNX were 45.6%, 64.8%, and 28%, and in healthy individuals were 7%, 7%, and 5.6%, respectively. Overall, our method produced 77.8% positive detections for at least 1 molecular marker. Twenty-eight (22.2%) were negative for expression of all markers, 39 (31.2%) were positive for expression of 1 marker, 42 (33.6%) were positive for expression of 2 markers, and 17 (13.6%) were positive for expression of all 3 markers. Detection of CK19 mRNA expression positively correlated with LC stage and distant metastases. PTHrP mRNA detection correlated positively with LC stage, presence of bone metastasis, and squamous cell carcinoma, and LUNX mRNA detection correlated with lymph node involvement. Combined detection of 2 or 3 markers was significantly correlated with metastatic disease, and negative detection of all 3 molecular markers was correlated with early stage nonmetastatic disease. CONCLUSION Multiple PCR-based detection of CK19, PTHrP, and LUNX mRNA expression provides useful information for disease stage and dissemination in LC patients.
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Affiliation(s)
- Anastasia Katseli
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Heterogeneity of ERα and ErbB2 Status in Cell Lines and Circulating Tumor Cells of Metastatic Breast Cancer Patients. Transl Oncol 2012; 5:475-85. [PMID: 23323159 DOI: 10.1593/tlo.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 09/06/2012] [Accepted: 10/30/2012] [Indexed: 02/07/2023] Open
Abstract
Hormone therapy and anti-ErbB2 therapies are prescribed according to the hormone receptor [estrogen receptor α (ERα)/progesterone receptor] and ErbB2 status of the initial tumor, but it appears that circulating tumor cells (CTCs) and, consequently, the metastatic cells may have a different receptor status. As an attempt to meet the crucial need for identification of the subpopulation of patients that will benefit from more individualized therapies, rapidly evolving therapies should allow a profiling of the tumors and/or of the CTCs. We established a triple fluorescence staining using eight cell lines to visualize the CTCs (cytokeratin detection) and then to define their individual ERα and ErbB2 status. Afterward, we used this method for blood samples from 26 metastatic breast cancer patients. We identified major differences of ERα levels between the cell lines and even within one cell line. For the metastatic patients, we detected and characterized CTCs in 38.5% of the patients with a total of 92 CTCs. We could demonstrate that at least 69.6% of the CTCs exhibit an ERα and/or ErbB2 status different from the status of the primary tumor and that the CTCs from only 30% of the patients had no change of receptor status. Strikingly, heterogeneities of the status, aggregation, and size clearly appear within the CTCs. The data we generated outline the importance of a profiling not only of tumors but also of CTCs to establish individualized treatments. CTCs may then appear as new prognosis and treatment marker for both metastatic and adjuvant breast cancers.
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Ignatiadis M, Piccart M. Liquid biopsy to test new treatment strategies in breast cancer: are we there yet? Ann Oncol 2012; 23:1653-5. [PMID: 22517821 DOI: 10.1093/annonc/mds111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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20
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Alsamarai S, Abu-Khalaf MM, Harris LN. DTCs/CTCs in breast cancer: five decades later. Recent Results Cancer Res 2012; 195:217-225. [PMID: 22527509 DOI: 10.1007/978-3-642-28160-0_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Since circulating tumor cells were first reported in 1955, the field has seen major advances in their detection and has established their prognostic impact. Here we review the current evidence for the prognostic and predictive value of circulating tumor cells in metastatic breast cancer. We then evaluate the role of CTCs and DTCs in early stage breast cancer. The weight of the evidence supports the role of CTCs and DTCs as prognostic indicators, however their role in therapy prediction remains unclear. Ongoing trials may provide answers and newer detection methods which improve sensitivity and specificity may have greater impact. At this point, the data does not support incorporation into clinical practice for early breast cancer patients.
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21
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Reinholz MM, Kitzmann KA, Tenner K, Hillman D, Dueck AC, Hobday TJ, Northfelt DW, Moreno-Aspitia A, Roy V, LaPlant B, Allred JB, Stella PJ, Lingle WL, Perez EA. Cytokeratin-19 and mammaglobin gene expression in circulating tumor cells from metastatic breast cancer patients enrolled in North Central Cancer Treatment Group trials, N0234/336/436/437. Clin Cancer Res 2011; 17:7183-93. [PMID: 21976532 DOI: 10.1158/1078-0432.ccr-11-0981] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To investigate the associations between baseline and posttreatment circulating tumor cell (CTC) gene expression and outcome of patients enrolled in four North Central Cancer Treatment Group metastatic breast cancer (MBC) trials in which specimens were shipped (at 4°C) from community-based sites to a reference laboratory (Mayo Clinic, Rochester, MN). EXPERIMENTAL DESIGN Blood was collected at treating sites from MBC patients before (baseline), during, and at the end of treatment with erlotinib + gemcitabine (N0234), sorafenib (N0336), irinotecan + cetuximab (N0436), or paclitaxel-poliglumex + capecitabine (N0437). CTCs from 10 mL of EDTA blood were enriched with CD45 depletion, 24 to 30 hours postblood collection. Reverse transcription/quantitative PCR was used to determine cytokeratin-19 (CK19) and mammaglobin (MGB1) mRNA levels in CTCs from up to 13 (N0234), 16 (N0336), 18 (N0436), and 39 (N0437) patients. The gene expressions were normalized to β(2)-microglobulin and calibrated to healthy blood using the 2(-ΔΔCq) algorithm; positivity was defined as 2 or more. RESULTS CK19+mRNA cells were detected in 56% to 75% and MGB1+mRNA cells in 23% to 38% of 86 patients at baseline. CK19+mRNA cells were detected in 30% to 67% and MGB1+mRNA cells in 14% to 64% of 110 postbaseline serial samples. The presence of baseline CK19+mRNA cells (P = 0.01) but not MGB1+mRNA cells (P = 0.14) was significantly associated with shorter overall survival. A decrease in MGB1+mRNA levels (baseline-week 8) seemed to be associated with clinical response (P = 0.05). CONCLUSIONS CTC gene expression analysis conducted by a reference laboratory is feasible when blood is collected from treating sites and processed 24 to 30 hours postcollection. The presence of baseline CK19+mRNA CTCs was associated with poor prognosis; a decrease in MGB1+mRNA CTCs may help predict response to therapy of MBC patients.
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Affiliation(s)
- Monica M Reinholz
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55906, USA.
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Sun YF, Yang XR, Zhou J, Qiu SJ, Fan J, Xu Y. Circulating tumor cells: advances in detection methods, biological issues, and clinical relevance. J Cancer Res Clin Oncol 2011; 137:1151-73. [PMID: 21681690 DOI: 10.1007/s00432-011-0988-y] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/26/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Circulating tumor cells (CTCs) have long been considered a reflection of tumor aggressiveness. Hematogenous spreading of CTCs from a primary tumor is a crucial step in the metastasis cascade, which leads ultimately to the formation of overt metastases. However, owing to the rarity of CTCs in peripheral blood, detecting these cells requires methods combined with high sensitivity and specificity, which sets tremendous challenges for the implementation of these assays into clinical routine. METHODS Generally, CTCs detection methods are composed of the following two steps: enrichment (isolation) process (morphological and immunological techniques) and detection (identification) process (cytometric and nucleic acid techniques), which may or may not be separate from enrichment. Genetic and molecular characterization of CTCs carried out by fluorescent in situ hybridization (FISH), comparative genomic hybridization (CGH), PCR-based techniques, and biomarker immunofluorescent staining extract more information about malignant profile, metastatic potential of CTCs, and the extent to which CTCs are genetically identical to the primary tumor. RESULTS Recent technical advances made it possible to detect CTCs. The efficacy of circulating tumor cell (CTC) detection among patients with solid malignancy has been investigated, which shows great potential to become a tool for real-time parameter of prognosis and serve as an early marker to assess the therapeutic response in overt cancers. Improvements in detection and characterization of CTCs will hopefully lead to refinement of clinical management of cancer patients. CONCLUSION This review addresses the majority of assays that have been published thus far, including the enrichment and detection steps and the markers used in these assays, accompanied by some biological issues of CTC and the results of clinical application harvested.
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Affiliation(s)
- Yun-Fan Sun
- Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Liver Cancer Institute, Zhong Shan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People's Republic of China
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Replication timing aberrations and aneuploidy in peripheral blood lymphocytes of breast cancer patients. Neoplasia 2010; 12:668-74. [PMID: 20689761 DOI: 10.1593/neo.10568] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 05/23/2010] [Accepted: 05/27/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Peripheral blood lymphocytes of patients with hematological malignancies or solid tumors, such as renal cell carcinoma or prostate cancer, display epigenetic aberrations (loss of synchronous replication of allelic counterparts) and genetic changes (aneuploidy) characteristic of the cancerous phenotype. This study sought to determine whether such alterations could differentiate breast cancer patients from cancer-free subjects. METHODS The HER2 locus-an oncogene assigned to chromosome 17 whose amplification is associated with breast cancer (BCA)-and the pericentromeric satellite sequence of chromosome 17 (CEN17) were used for replication timing assessments. Aneuploidy was monitored by enumerating the copy numbers of chromosome 17. Replication timing and aneuploidy were detected cytogenetically using fluorescence in situ hybridization technology applied to phytohemagglutinin-stimulated lymphocytes of 20 women with BCA and 10 control subjects. RESULTS We showed that both the HER2 and CEN17 loci in the stimulated BCA lymphocytes altered their characteristic pattern of synchronous replication and exhibited asynchronicity. In addition, there was an increase in chromosome 17 aneuploidy. The frequency of cells displaying asynchronous replication in the patients' samples was significantly higher (P < 10(-12) for HER2 and P < 10(-6) for CEN17) than the corresponding values in the control samples. Similarly, aneuploidy in patients' cells was significantly higher (P < 10(-9)) than that in the controls. CONCLUSIONS The HER2 and CEN17 aberrant replication differentiated clearly between BCA patients and control subjects. Thus, monitoring the replication of these genes offers potential blood markers for the detection and monitoring of breast cancer.
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Cheng JP, Yan Y, Wang XY, Lu YL, Yuan YH, Wang XL, Jia J, Ren J. Circulating tumor cells in metastatic breast cancer: Monitoring response to chemotherapy and predicting progression-free survival. Chin J Cancer Res 2010. [DOI: 10.1007/s11670-010-0201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kowalewska M, Nowak R, Chechlinska M. Implications of cancer-associated systemic inflammation for biomarker studies. Biochim Biophys Acta Rev Cancer 2010; 1806:163-71. [PMID: 20600631 DOI: 10.1016/j.bbcan.2010.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 12/19/2022]
Abstract
Highly sensitive molecular technologies provide new capacities for cancer biomarker research, but with sensitivity improvements marker specificity is significantly decreased, and too many false-positive results should disqualify the measurement from clinical use. Hence, of the thousands of potential cancer biomarkers only a few have found their way to clinical application. Differentiating false-positive results from true-positive (cancer-specific) results can indeed be difficult, if validation of a marker is performed against inadequate controls. We present examples of accumulating evidence that not only local but also systemic inflammatory reactions are implicated in cancer development and progression and interfere with the molecular image of cancer disease. We analyze several modern strategies of tumor marker discovery, namely, proteomics, metabonomics, studies on circulating tumor cells and circulating free nucleic acids, or their methylation degree, and provide examples of scarce, methodologically correct biomarker studies as opposed to numerous methodologically flawed biomarker studies, that examine cancer patients' samples against those of healthy, inflammation-free persons and present many inflammation-related biomarker alterations in cancer patients as cancer-specific. Inflammation as a cancer-associated condition should always be considered in cancer biomarker studies, and biomarkers should be validated against their expression in inflammatory conditions.
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Affiliation(s)
- Magdalena Kowalewska
- Department of Molecular Biology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
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Rosa FE, Silveira SM, Silveira CGT, Bérgamo NA, Neto FAM, Domingues MAC, Soares FA, Caldeira JRF, Rogatto SR. Quantitative real-time RT-PCR and chromogenic in situ hybridization: precise methods to detect HER-2 status in breast carcinoma. BMC Cancer 2009; 9:90. [PMID: 19309522 PMCID: PMC2667535 DOI: 10.1186/1471-2407-9-90] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 03/23/2009] [Indexed: 11/29/2022] Open
Abstract
Background HER-2 gene testing has become an integral part of breast cancer patient diagnosis. The most commonly used assay in the clinical setting for evaluating HER-2 status is immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). These procedures permit correlation between HER-2 expression and morphological features. However, FISH signals are labile and fade over time, making post-revision of the tumor difficult. CISH (chromogenic in situ hybridization) is an alternative procedure, with certain advantages, although still limited as a diagnostic tool in breast carcinomas. Methods To elucidate the molecular profile of HER-2 status, mRNA and protein expression in 75 invasive breast carcinomas were analyzed by real time quantitative RT-PCR (qRT-PCR) and IHC, respectively. Amplifications were evaluated in 43 of these cases by CISH and in 11 by FISH. Results The concordance rate between IHC and qRT-PCR results was 78.9%, and 94.6% for qRT-PCR and CISH. Intratumoral heterogeneity of HER-2 status was identified in three cases by CISH. The results of the three procedures were compared and showed a concordance rate of 83.8%; higher discordances were observed in 0 or 1+ immunostaining cases, which showed high-level amplification (15.4%) and HER-2 transcript overexpression (20%). Moreover, 2+ immunostaining cases presented nonamplified status (50%) by CISH and HER-2 downexpression (38.5%) by qRT-PCR. In general, concordance occurred between qRT-PCR and CISH results. A high concordance was observed between CISH/qRT-PCR and FISH. Comparisons with clinicopathological data revealed a significant association between HER-2 downexpression and the involvement of less than four lymph nodes (P = 0.0350). Conclusion Based on these findings, qRT-PCR was more precise and reproducible than IHC. Furthermore, CISH was revealed as an alternative and useful procedure for investigating amplifications involving the HER-2 gene.
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Affiliation(s)
- Fabíola E Rosa
- Department of Genetics, Institute of Biosciences, UNESP, São Paulo State University, Botucatu, Sao Paulo, Brazil.
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