A Comprehensive Molecular Analysis of in Vivo Isolated EpCAM-Positive Circulating Tumor Cells in Breast Cancer

BACKGROUND

Circulating tumor cell (CTC) analysis is highly promising for liquid biopsy-based molecular diagnostics. We undertook a comprehensive molecular analysis of in vivo isolated CTCs in breast cancer (BrCa).

METHODS

In vivo isolated CTCs from 42 patients with early and 23 patients with metastatic breast cancer (MBC) were prospectively collected and analyzed for gene expression, DNA mutations, and DNA methylation before and after treatment. 19 healthy donor (HD) samples were analyzed as a control group. In identical blood draws, CTCs were enumerated using CellSearch® and characterized by direct IF staining.

RESULTS

All 19 HD samples were negative for CK8, CK18, CK19, ERBB2, TWIST1, VEGF, ESR1, PR, and EGFR expression, while CD44, CD24, ALDH1, VIM, and CDH2 expression was normalized to B2M (reference gene). At least one gene was expressed in 23/42 (54.8%) and 8/13 (61.5%) CTCs in early BrCa before and after therapy, and in 20/23 (87.0%) and 5/7 (71.4%) MBC before and after the first cycle of therapy. PIK3CA mutations were detected in 11/42 (26.2%) and 3/13 (23.1%) in vivo isolated CTCs in early BrCa before and after therapy, and in 11/23 (47.8%) and 2/7 (28.6%) MBC, respectively. ESR1 methylation was detected in 5/32 (15.7%) and 1/10 (10.0%) CTCs in early BrCa before and after therapy, and in 3/15(20.0%) MBC before the first line of therapy. The comprehensive molecular analysis of CTC revealed a higher sensitivity in relation to CellSearch or IF staining when based on creatine kinase selection.

CONCLUSIONS

In vivo-CTC isolation in combination with a comprehensive molecular analysis at the gene expression, DNA mutation, and DNA methylation level comprises a highly powerful approach for molecular diagnostic applications using CTCs.

Characterization of circulating breast cancer cells with tumorigenic and metastatic capacity

Functional studies giving insight into the biology of circulating tumor cells (CTCs) remain scarce due to the low frequency of CTCs and lack of appropriate models. Here, we describe the characterization of a novel CTC‐derived breast cancer cell line, designated CTC‐ITB‐01, established from a patient with metastatic estrogen receptor‐positive (ER⁺) breast cancer, resistant to endocrine therapy. CTC‐ITB‐01 remained ER⁺ in culture, and copy number alteration (CNA) profiling showed high concordance between CTC‐ITB‐01 and CTCs originally present in the patient with cancer at the time point of blood draw. RNA‐sequencing data indicate that CTC‐ITB‐01 has a predominantly epithelial expression signature. Primary tumor and metastasis formation in an intraductal PDX mouse model mirrored the clinical progression of ER⁺ breast cancer. Downstream ER signaling was constitutively active in CTC‐ITB‐01 independent of ligand availability, and the CDK4/6 inhibitor Palbociclib strongly inhibited CTC‐ITB‐01 growth. Thus, we established a functional model that opens a new avenue to study CTC biology.

Real-world use and acceptance of rituximab biosimilars in non-Hodgkin lymphoma in an oncologist network in Germany

Aim: Present real-world data for rituximab (biosimilar and reference)-containing regimens in extrapolated indications in non-Hodgkin lymphoma (NHL)/chronic lymphocytic leukemia (CLL). Patients & methods: Data collected from office-based oncologic practices in Germany (July 2017–June 2019). Results: Of 1741 patients, 1241 had NHL; 500 had CLL. Of 7595 therapy cycles, 28.3% used reference rituximab; 55.2% used rituximab biosimilars; 2.0% used subcutaneous rituximab; 14.5% used rituximab, not otherwise specified. Rituximab biosimilars were used across all indications; 57.3% of cycles were administered in extrapolated indications. Over 24 months, the proportion of rituximab prescriptions that were for biosimilars increased from 12.0 to 83.0%. Conclusion: Our real-world data in NHL and CLL depicts increasing use of rituximab biosimilars across multiple treatment protocols, including extrapolated indications.

Tumor-Associated Release of Prostatic Cells into the Blood after Transrectal Ultrasound-Guided Biopsy in Patients with Histologically Confirmed Prostate Cancer

BACKGROUND

Transrectal ultrasound-guided prostate biopsy (TRUS) is a standard procedure for prostate cancer diagnosis. Because prostate cancer is a multifocal disease in many patients, multiple sampling (n ≥ 10) is required, which may bear the risk of systemic spread of cancer cells.

DESIGN

Using the standardized CellSearch® system that allows for the detection of single epithelial cell adhesion molecule-positive circulating tumor cells (CTCs) in blood, we investigated whether prostate biopsy is associated with release of prostatic tumor cells into the circulation. Peripheral blood was obtained before and within 30 min after performing prostate biopsy from 115 men with increased serum prostate-specific antigen.

RESULTS

The number of CTCs significantly increased after biopsy in men with histologically confirmed prostate cancer (odds ratio, 7.8; 95% CI, 4.8–12.8), whereas no biopsy-related changes could be detected in men without confirmed prostate cancer. Multivariable analysis showed that biopsy-related increase of CTCs was significantly correlated with a worse progression-free survival (hazard ratio, 12.4; 95% CI, 3.2–48.6) within the median follow-up of 41 months.

CONCLUSIONS

Prostate biopsies may lead to a tumor-associated release of CTCs into the blood circulation. Larger confirmatory trials with longer follow-up periods are required before any change in clinical practice can be recommended.

Multiplex Gene Expression Profiling of In Vivo Isolated Circulating Tumor Cells in High-Risk Prostate Cancer Patients

BACKGROUND

Molecular characterization of circulating tumor cells (CTCs) is important for selecting patients for targeted treatments. We present, for the first time, results on gene expression profiling of CTCs isolated in vivo from high-risk prostate cancer (PCa) patients compared with CTC detected by 3 protein-based assays-CellSearch^®, PSA-EPISPOT, and immunofluorescence of CellCollector^® in vivo-captured CTCs-using the same blood draw.

METHODS

EpCAM-positive CTCs were isolated in vivo using the CellCollector from 108 high-risk PCa patients and 36 healthy volunteers. For 27 patients, samples were available before and after treatment. We developed highly sensitive multiplex RT-qPCR assays for 14 genes (KRT19, EpCAM, CDH1, HMBS, PSCA, ALDH1A1, PROM1, HPRT1, TWIST1, VIM, CDH2, B2M, PLS3, and PSA), including epithelial markers, stem cell markers, and epithelial-to-mesenchymal-transition (EMT) markers.

RESULTS

We observed high heterogeneity in gene expression in the captured CTCs for each patient. At least 1 marker was detected in 74 of 105 patients (70.5%), 2 markers in 45 of 105 (40.9%), and 3 markers in 16 of 105 (15.2%). Epithelial markers were detected in 31 of 105 (29.5%) patients, EMT markers in 46 of 105 (43.8%), and stem cell markers in 15 of 105 (14.3%) patients. EMT-marker positivity was very low before therapy (2 of 27, 7.4%), but it increased after therapy (17 of 27, 63.0%), whereas epithelial markers tended to decrease after therapy (2 of 27, 7.4%) compared with before therapy (13 of 27, 48.1%). At least 2 markers were expressed in 40.9% of patients, whereas the positivity was 19.6% for CellSearch, 38.1% for EPISPOT, and 43.8% for CellCollector-based IF-staining.

CONCLUSIONS

The combination of in vivo CTC isolation with downstream RNA analysis is highly promising as a high-throughput, specific, and ultrasensitive approach for multiplex liquid biopsy-based molecular diagnostics.

Abstract 1716: GSTP1 promoter methylation in in-vivo isolated CTCs from high-risk prostate cancer patients

Introduction: Glutathione S-transferase 1 (GSTP1) has been reported to function as tumor suppressor gene in various types of human cancers. GSTP1 inactivation is associated with CpG island promoter hypermethylation in the majority of prostate cancers (PCs). The initiation of minimal residual disease (MRD) and especially the detection of circulating tumor cells (CTCs) in patients’ peripheral blood represents a negative prognostic parameter for recurrence-free survival. The aim of the present study was to assess the methylation status of the GSTP1 gene in CTCs that were isolated, using the CellCollector® (GILUPI, GmbH), a novel clinical device designed for the in vivo isolation of EpCAM-positive CTCs. Patients and methods: In-vivo isolation of CTCs was performed by using CellCollector® from high-risk prostate cancer patients (n=97) and 20 healthy volunteers. For all these patients, the Ab coated region of the CellCollector® was washed in PBS , cut, and stored in Trizol reagent till analysis and DNA was further prior to the analysis isolated DNA was modified by sodium bisulfite (SB) and subjected to a real time MSP assay specific for GSTP1 methylation. In all cases, peripheral blood was also collected and used for CTC analysis by Immunostaining and the CellSearch® system. Results: All DNA samples were first checked for their quality. Based on the quality evaluation of all available DNA samples, only 63 DNAs were further qualified for analysis. GSTP1 promoter was found methylated in 12/63 (19%) the EpCAM positive fraction of in-vivo isolated CTCs. Moreover, in 5/12 (41.7%) patients for which GSTP1 promoter was found methylated, CTCs were also detected by the CellSearch® and 7 /12 (58.3%) for which GSTP1 promoter was also found positive, CTCs were also detected by the Immunostaining. Conclusion: GSTP1 promoter is methylated in in-vivo isolated CTCs from high-risk prostate cancer patients. GSTP1 promoter methylation in in-vivo isolated CTCs should be prospectively validated as a novel tumor biomarker for prostate cancer patients in a large cohort of patients. Acknowledgements: This research has been co-financed by the European Union (European Regional Development Fund - ERDF) and Greek national funds through the Operational Program ‘‘Competitiveness and Entrepreneurship’’ of the National Strategic Reference Framework (NSRF) - Research Funding Program: “ERA-NET on Translational Cancer Research (TRANSCAN) Joint Transnational Call for Proposals 2011 (JTC 2011) on: “Validation of biomarkers for personalised cancer medicine

Citation Format: Athina N. Markou, Panagiotis Paraskevopoulos, Marifili Lazaridou, Shukun Chen, Thomas Kroneis, Monika Świerczewska, Joanna Budna, Andra Kuske, Tobias M. Gorges, Maciej Zabel, Peter Sedlmayr, Catherine Alix-Panabieres, Klaus Pantel, Evi Lianidou. GSTP1 promoter methylation in in-vivo isolated CTCs from high-risk prostate cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1716. doi:10.1158/1538-7445.AM2017-1716

Accession of Tumor Heterogeneity by Multiplex Transcriptome Profiling of Single Circulating Tumor Cells

BACKGROUND

Transcriptome analysis of circulating tumor cells (CTCs) holds great promise to unravel the biology of cancer cell dissemination and identify expressed genes and signaling pathways relevant to therapeutic interventions.

METHODS

CTCs were enriched based on their EpCAM expression (CellSearch®) or by size and deformability (ParsortixTM), identified by EpCAM and/or pan-keratin–specific antibodies, and isolated for single cell multiplex RNA profiling.

RESULTS

Distinct breast and prostate CTC expression signatures could be discriminated from RNA profiles of leukocytes. Some CTCs positive for epithelial transcripts (EpCAM and KRT19) also coexpressed leukocyte/mesenchymal associated markers (PTPRC and VIM). Additional subsets of CTCs within individual patients were characterized by divergent expression of genes involved in epithelial–mesenchymal transition (e.g., CDH2, MMPs, VIM, or ZEB1 and 2), DNA repair (RAD51), resistance to cancer therapy (e.g., AR, AR-V7, ERBB2, EGFR), cancer stemness (e.g., CD24 and CD44), activated signaling pathways involved in tumor progression (e.g., PIK3CA and MTOR) or cross talks between tumors and immune cells (e.g., CCL4, CXCL2, CXCL9, IL15, IL1B, or IL8).

CONCLUSIONS

Multimarker RNA profiling of single CTCs reveals distinct CTC subsets and provides important insights into gene regulatory networks relevant for cancer progression and therapy.

Abstract 503: Molecular characterization of in vivo isolated EpCAM-positive circulating tumor cells in breast cancer

Introduction: In the early stages of cancer, the chance to detect rare CTCs is increasing by increasing the sample volume. The aim of our study was to evaluate the diagnostic sensitivity of a novel clinical device for the in-vivo isolation of EpCAM-positive CTCs (CellCollectorTM, GILUPI, GmBH), by using highly sensitive RT-qPCR molecular assays.

Patients and methods: 29 breast cancer patients without overt metastases before the beginning of adjuvant chemotherapy (M0), 26 breast cancer patients with overt metastases before starting of therapy (M1) and 12/26 of them before the second cycle of therapy (M2), as well as 18 healthy donors participated in the study. After in-vivo isolation, total RNA was extracted from captured cells, lysed in Trizol, followed by cDNA synthesis. RT-qPCR was used for the molecular characterization of captured cells, for: CK-19, HER-2, TWIST1, VEGF, ER, PR, EGFR, CD44, CD24, and ALDH1, while B2M was used as a reference gene. Peripheral blood was also collected for CTC analysis by the FDA cleared CellSearchTM system. In addition, immunofluorescence staining of cytospins was performed and screened for CTCs using the ARIOL system, using ER, HER2, CK (8, 18, 19) and CD45 for CTC identification.

Results: Results are shown in Table 1. At least one gene was expressed in 10(34.5%) of M0, 15(57.7%) of M1 and 4(33.3%) of M2 patient groups, but in none of healthy donors 0/18(0%). CellSearchTM gave positive results in 5(17.2%) of M0, 10(38.5%) of M1 and 0(0%) of M2. Immunofluorescence (Ariol system) was positive for ER, HER2, CK (8, 18, 19) in 5/15(33.3%) M0, in 4/12(33.3%) M1 and in 1/7(14.3%) M2 groups. Table 1.Gene expression in CTCHealthy N = 18M0 N = 29M1 N = 26M2 N = 12CK-190 (0%)6(20.7%)6 (23.1%)2 (16.7%)HER20 (0%)2 (6.9%)0 (0%)0 (0%)ER0 (0%)2 (6.9%)0 (0%)0 (0%)PR0 (0%)0 (0%)0 (0%)0 (0%)EGFR0 (0%)0 (0%)0 (0%)0 (0%)TWIST10 (0%)1 (3.4%)0 (0%)2 (16.7%)VEGF0 (0%)3 (10.3%)5 (19.2%)1 (8.3%)CD44+/CD24−,0 (0%)4 (13.8%)3 (11.5%)1 (8.3%)ALDH1high/CD24−,0 (0%)2 (6.9%)8 (30.8%)1(8.3%)

Conclusions: In-vivo isolation of CTC is minimally invasive, and in combination with high specific and sensitive RT-qPCR assays for CTC detection and molecular characterization seems promising. Comparison studies with the CellSearch and immunofluorescence have shown poor agreement. These results should be validated in large patient cohorts, and in respect to the clinical outcome.

Citation Format: Areti D. Strati, Martha Zavridou, Galateia Kallergi, Eleni Politaki, Tobias Gorges, Andra Kuske, Anna-Lena Bohnen, George Koutsodontis, Amanda Psyrri, Klaus Lucke, Vasilis Georgoulias, Klaus Pantel, Evi Lianidou. Molecular characterization of in vivo isolated EpCAM-positive circulating tumor cells in breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 503.

Heat and immunity: an experimental heat wave alters immune functions in three-spined sticklebacks (Gasterosteus aculeatus)

Global climate change is predicted to lead to increased temperatures and more extreme climatic events. This may influence host-parasite interactions, immunity and therefore the impact of infectious diseases on ecosystems. However, little is known about the effects of rising temperatures on immune defence, in particular in ectothermic animals, where the immune system is directly exposed to external temperature change. Fish are ideal models for studying the effect of temperature on immunity, because they are poikilothermic, but possess a complete vertebrate immune system with both innate and adaptive immunity. We used three-spined sticklebacks ( Gasterosteus aculeatus) originating from a stream and a pond, whereby the latter supposedly were adapted to higher temperature variation. We studied the effect of increasing and decreasing temperatures and a simulated heat wave with subsequent recovery on body condition and immune parameters. We hypothesized that the immune system might be less active at low temperatures, but will be even more suppressed at temperatures towards the upper tolerable temperature range. Contrary to our expectation, we found innate and adaptive immune activity to be highest at a temperature as low as 13 °C. Exposure to a simulated heat wave induced long-lasting immune disorders, in particular in a stickleback population that might be less adapted to temperature variation in its natural environment. The results show that the activity of the immune system of an ectothermic animal species is temperature dependent and suggest that heat waves associated with global warming may immunocompromise host species, thereby potentially facilitating the spread of infectious diseases.

Second to fourth digit ratio and prostate cancer severity

BACKGROUND

The ratio of the second to the fourth digit (2D:4D ratio) is a sexually dimorphic trait established in utero that differs between ethnic groups. It is associated with prenatal androgen exposure, and studies have evaluated the ratio as a marker for certain traits and disease states known to be associated with higher levels of in utero androgens, such as prostate cancer. There are currently no screening tools that stratify men with prostate cancer according to the severity of their disease. This study aims to investigate the 2D:4D ratio as a potential marker for prostate cancer severity. Our hypothesis was that lower digit ratios, representing higher in utero androgen exposure, would be associated with more severe disease.

METHODS

Measurements were taken of the second and fourth digits of the right hand of male patients diagnosed with prostate cancer. Gleason score, presence of metastasis, family history, age at diagnosis and race were recorded. The distribution of demographic and other patient characteristics were compared with digit ratios to determine relationships.

RESULTS

African-American men with prostate cancer are 3.70 times more likely to have a low 2D:4D digit ratio than Caucasian men with prostate cancer (95% confidence interval: 1.98, 6.92; P < 0.0001). There were no statistically significant differences in the presence of metastasis, Gleason score, family history or age at diagnosis by digit ratio.

CONCLUSION

2D:4D ratio shows strong differences between African-Americans and Caucasians; however, it does not correlate with disease severity in men already diagnosed with prostate cancer. Although this is a small population sample with possible confounding factors, it does not provide evidence to support the hypothesis that prenatal androgens affect prostate cancer grade or progression.