May CTC technologies promote better cancer management?

Abstract

In the case of cancer, death is usually not due to the primary tumor itself but due to dissemination. Analysis of the circulating tumor cells (CTCs), i.e., cells responsible for a formation of metastases, should provide information useful for the management of cancer patients, fulfilling the objectives of predictive, preventive, and personalized medicine (PPPM). Despite promising results, the decisions on stage of disease and how to guide the adjuvant treatment still do not include results of CTC assessment. We want to describe two major reasons why the recent diagnostic value of CTC analysis is not sufficient for clinical use. The first reason arises from the biological nature of the tumor itself and the second reason is associated with an interdisciplinary status of CTC diagnostics in the sense that it is neither a theme purely for pathologists nor for haemato-oncologists nor clinical biochemists. We anticipate that there are at least three areas where CTCs can be useful for clinical practice. The first is monitoring of treatment efficacy of cancer patients. The second is a molecular characterization of captured CTCs for targeted treatment, and the third is a cultivation of captured CTCs for drug sensitivity testing. All of these approaches allow researchers recognize and respond to changes of phenotype of cancer cells during disease progression and introduce PPPM into clinical practice.

Circulating tumor microemboli (CTM) and vimentin+ circulating tumor cells (CTCs) detected by a size-based platform predict worse prognosis in advanced colorectal cancer patients during chemotherapy

“…There was increasing evidence which prove CTCs as the clinical marker for diagnostic, prognostic, and pharmacologic purposes [21, 22]. Hence, CTC detection and characterization had become a research focus worldwide.…”

“…Moreover, the CTC detection rate in advanced CRC patients during 2 ~ 6 cycles chemotherapy was 49% (48 of 98 patients), which was significantly higher than that detected by CellSearch system (data showed in meta-analysis) [23, 24], and it was consistent with the results of another study which compared CTC detection rate of the size-based platform and the CellSearch system in esophageal carcinoma [25]. The high sensitivity of this size-based platform could be mainly attributed to two factors: Firstly, the CellSearch system only regarded tumor cells with epithelial phenotype in peripheral blood as CTCs, which did not take other properties and processes which were associated with malignant potential into consideration, such as EMT, cohesive and collective cell migration [22]. Secondly, this size-based platform captured malignant cells by the difference of diameter and deformability between abnormal cells and haemocytes, hence it could isolate more abnormal cells for further identifying CTCs.…”

Molecular Profiling of Circulating Tumour Cells Identifies Notch1 as a Principal Regulator in Advanced Non-Small Cell Lung Cancer

“…This is particularly relevant in NSCLC, where most cases result inoperable and biopsies are rarely obtainable. The analysis and characterization of CTCs in NSCLC patients represent a particularly attractive strategy for real-time patient monitoring to support treatment decisions1415.…”

Circulating Tumour Cells in Predictive Molecular Pathology: Focus on Drug-Sensitive Assays and 3D Culture

“…The identification of CTCs can help to improve personalised medicine for cancer patients. In fact, CTCs can be used to perform sensitivity assays to test the efficacy of such treatments in each patient [68, 69]. Moreover, CTCs detach from the primary mass and generate metastases, thereby overcoming the molecular heterogeneity of the tumour mass [68-70].…”