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Papadaki MA, Sotiriou AI, Vasilopoulou C, Filika M, Aggouraki D, Tsoulfas PG, Apostolopoulou CA, Rounis K, Mavroudis D, Agelaki S. Optimization of the Enrichment of Circulating Tumor Cells for Downstream Phenotypic Analysis in Patients with Non-Small Cell Lung Cancer Treated with Anti-PD-1 Immunotherapy. Cancers (Basel) 2020; 12:cancers12061556. [PMID: 32545559 PMCID: PMC7352396 DOI: 10.3390/cancers12061556] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022] Open
Abstract
The current study aimed at the optimization of circulating tumor cell (CTC) enrichment for downstream protein expression analyses in non-small cell lung cancer (NSCLC) to serve as a tool for the investigation of immune checkpoints in real time. Different enrichment approaches—ficoll density, erythrolysis, their combination with magnetic separation, ISET, and Parsortix—were compared in spiking experiments using the A549, H1975, and SKMES-1 NSCLC cell lines. The most efficient methods were tested in patients (n = 15) receiving immunotherapy targeting programmed cell death-1 (PD-1). Samples were immunofluorescently stained for a) cytokeratins (CK)/epithelial cell adhesion molecule (EpCAM)/leukocyte common antigen (CD45), and b) CK/programmed cell death ligand-1 (PD-L1)/ indoleamine-2,3-dioxygenase (IDO). Ficoll, ISET, and Parsortix presented the highest yields and compatibility with phenotypic analysis; however, at the patient level, they provided discordant CTC positivity (13%, 33%, and 60% of patients, respectively) and enriched for distinct CTC populations. IDO and PD-L1 were expressed in 44% and 33% and co-expressed in 19% of CTCs. CTC detection was associated with progressive disease (PD) (p = 0.006), reduced progression-free survival PFS (p = 0.007), and increased risk of relapse (hazard ratio; HR: 10.733; p = 0.026). IDO-positive CTCs were associated with shorter PFS (p = 0.039) and overall survival OS (p = 0.021) and increased risk of death (HR: 5.462; p = 0.039). The current study indicates that CTC analysis according to distinct immune checkpoints is feasible and may provide valuable biomarkers to monitor NSCLC patients treated with anti-PD-1 agents.
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Affiliation(s)
- Maria A Papadaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Afroditi I Sotiriou
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Christina Vasilopoulou
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Maria Filika
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Despoina Aggouraki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Panormitis G Tsoulfas
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Christina A Apostolopoulou
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
| | - Konstantinos Rounis
- Department of Medical Oncology, University General Hospital of Heraklion, 71110 Heraklion, Vassilika Vouton, Crete, Greece;
| | - Dimitrios Mavroudis
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
- Department of Medical Oncology, University General Hospital of Heraklion, 71110 Heraklion, Vassilika Vouton, Crete, Greece;
| | - Sofia Agelaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71110 Heraklion, Vassilika Vouton, Crete, Greece; (M.A.P.); (A.I.S.); (C.V.); (M.F.); (D.A.); (P.G.T.); (C.A.A.); (D.M.)
- Department of Medical Oncology, University General Hospital of Heraklion, 71110 Heraklion, Vassilika Vouton, Crete, Greece;
- Correspondence: ; Tel.: +30-2810394712
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