Liquid Biopsy in Endometrial Cancer: New Opportunities for Personalized Oncology

Abstract

The identification of new molecular targets and biomarkers associated with high risk of recurrence and response to therapy represents one of the main clinical challenges in the management of advanced disease in endometrial cancer. In this sense, the field of liquid biopsy has emerged as a great revolution in oncology and is considered “the way” to reach personalised medicine. In this review, we discuss the promising but already relatively limited advances of liquid biopsy in endometrial cancer compared to other types of tumours like breast, colorectal or prostate cancer. We present recent data analysing circulating tumour material in minimally-invasive blood samples, but also in alternative forms of liquid biopsy like uterine aspirates. Proteomic and genomic studies focused on liquid-based uterine samples are resulting not only in optimal diagnostic tools but also in reliable approaches to address tumour heterogeneity. Likewise, circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) represent an opportunity for the correct stratification of patients, for the assessment of early recurrent disease or for the real-time monitoring of therapy responses. Appropriately designed studies and implementation in clinical trials will determine the value of liquid biopsy for precision oncology in endometrial cancer.

Genomic Profiling of Uterine Aspirates and cfDNA as an Integrative Liquid Biopsy Strategy in Endometrial Cancer

“…The advantages of using liquid biopsies rather than tissue samples are clear: the samples are easy to obtain, provide information in real time, and improve the understanding of tumor heterogeneity [16]. Nevertheless, despite the many technical improvements in liquid biopsies in other tumors during the past two decades, information regarding the clinical benefit of using these alternative biopsies to manage patients with EC is quite limited [6].…”

“…Major advantages of liquid biopsy analysis include its minimal invasiveness and ability to provide real-time information about the disease [5]. To date, the utility of liquid biopsy in EC has been scarcely explored [6]. The presence of CTCs has been shown to be limited in EC, and a small number of high-risk patients, mainly those with non-endometrioid high grade carcinomas, have been identified with Epithelial Cell Adhesion Molecule (EpCAM) positive CTCs in circulation at the time of diagnosis.…”

Analysis of miRNA inhibitors Efficacy using Capillary Electrophoresis with Laser-Induced Fluorescence

“…36 The quantity and genomic variation characteristics of CTCs have also shown intra-tumor heterogeneity and can provide comprehensive diagnostic information of a number of cancers. 37,38 Although the advantages of cfDNA and CTCs make them promising tools, more sensitive techniques must be developed to exploit their full promise. 39,40 In this study, we investigated the feasibility of using a targeted sequencing panel of 51 actionable genes in cancers to identify cfDNA and ctcDNA variants in patients with the five main types of gynecologic cancers.…”

New perspectives on screening and early detection of endometrial cancer

“…Several noninvasive gynecologic sampling methods and technologies (genomic, epigenomic and proteomic approaches) have been evaluated to detect endometrial cancer (Table ). We do not discuss here nongynecologic approaches, such as serum cytokines, chemokines, growth factors or ctDNA . Pap smears are routinely used in cervical cancer screening activities among the general population, causing minimal discomfort and hence being widely acceptable to women.…”

“…We do not discuss here nongynecologic approaches, such as serum cytokines, chemokines, growth factors or ctDNA. 90,91 Pap smears are routinely used in cervical cancer screening activities among the general population, causing minimal discomfort and hence being widely acceptable to women. At the end of his career, Dr George Papanicolau became interested in the diagnostic value of cervicovaginal smears in detecting endometrial cancer.…”