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The Evolving Role of Circulating Tumor Cells in the Personalized Management of Breast Cancer: From Enumeration to Molecular Characterization

  • Translational Research (V Stearns, Section Editor)
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Abstract

Circulating tumor cells (CTCs) represent tumor cells in the blood stream dislodged from the primary tumor. The presence of CTCs in the bloodstream provides a unique opportunity to sample cancer tissue by means of a relatively less-invasive “liquid biopsy.” Over the past decade, there has been a tremendous increase in the amount of research examining the potential clinical utility of CTCs in the management of cancer. A number of techniques to refine the sensitivity and range of CTC assays are also in development. In this article, we review the recent developments in the current and potential clinical applications of CTCs in breast cancer. CTC enumeration already has an established role as a prognostic biomarker in metastatic breast cancer, whereas molecular characterization of CTCs can serve as a potential predictive biomarker for therapy selection, pharmacodynamic evaluation, and identification of novel actionable targets for novel therapies. The role of CTCs in breast cancer screening and detection of recurrence is currently limited. Further development in techniques will be pivotal in enhancing the broad applicability of CTCs and advancing the field of personalized breast cancer therapy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ghossein RA, Bhattacharya S, Rosai J. Molecular detection of micrometastases and circulating tumor cells in solid tumors. Clin Cancer Res. 1999;5:1950–60.

    CAS  PubMed  Google Scholar 

  2. Racila E, Euhus D, Weiss AJ, et al. Detection and characterization of carcinoma cells in the blood. Proc Natl Acad Sci U S A. 1998;95:4589–94.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Cristofanilli M, Budd GT, Ellis MJ, et al. Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 2004;351:781–91.

    Article  CAS  PubMed  Google Scholar 

  4. Peeters DJ, De Laere B, Van den Eynden GG, et al. Semiautomated isolation and molecular characterisation of single or highly purified tumour cells from Cell Search enriched blood samples using dielectrophoretic cell sorting. Br J Cancer. 2013;108:1358–67.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Vona G, Sabile A, Louha M, et al. Isolation by size of epithelial tumor cells: a new method for the immunomorphological and molecular characterization of circulating tumor cells. Am J Pathol. 2000;156:57–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Aerts J, Wynendaele W, Paridaens R, et al. A real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) to detect breast carcinoma cells in peripheral blood. Ann Oncol. 2001;12:39–46.

    Article  CAS  PubMed  Google Scholar 

  7. Ko Y, Klinz M, Totzke G, Gouni-Berthold I, Sachinidis A, Vetter H. Limitations of the reverse transcription-polymerase chain reaction method for the detection of carcinoembryonic antigen-positive tumor cells in peripheral blood. Clin Cancer Res. 1998;4:2141–6.

    CAS  PubMed  Google Scholar 

  8. Krivacic RT, Ladanyi A, Curry DN, et al. A rare-cell detector for cancer. Proc Natl Acad Sci U S A. 2004;101:10501–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Nagrath S, Sequist LV, Maheswaran S, et al. Isolation of rare circulating tumour cells in cancer patients by microchip technology. Nature. 2007;450:1235–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Yu M, Bardia A, Wittner BS, et al. Circulating breast tumor cells exhibit dynamic changes in epithelial and mesenchymal composition. Science. 2013;339:580–4. This study reports a novel method of identify mesenchymal CTCs in breast cancer and correlates them with disease progression.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Hayes DF, Cristofanilli M, Budd GT, et al. Circulating tumor cells at each follow-up time point during therapy of metastatic breast cancer patients predict progression-free and overall survival. Clin Cancer Res. 2006;12(14 Pt 1):4218–24.

    Article  CAS  PubMed  Google Scholar 

  12. Pierga JY, Hajage D, Bachelot T, et al. High independent prognostic and predictive value of circulating tumor cells compared with serum tumor markers in a large prospective trial in first-line chemotherapy for metastatic breast cancer patients. Ann Oncol. 2012;23:618–24. This prospective series of patients confirms the independent prognostic impact of CTCs and compares them with established tumor markers in metastatic breast cancer.

    Article  PubMed  Google Scholar 

  13. Liu MC, Shields PG, Warren RD, et al. Circulating tumor cells: a useful predictor of treatment efficacy in metastatic breast cancer. J Clin Oncol. 2009;27:5153–9.

    Article  PubMed  Google Scholar 

  14. Bardia A, Huang P, Zhang Z, Sokoll L, Ingle JN, Carey LA, et al. Circulating tumor cells (CTCs) and CA27.29 as predictors of outcome in metastatic breast cancer (MBC) patients in the prospective TBCRC 005 Biomarker study. J Clin Oncol. 2010;28(Suppl):1001. [Abstract]. Clinical trial demonstrated that change in CA2729 change from baseline to week 3–4 post-therapy was independently and more strongly associated with progression of disease compared with change in CTC count.

    Google Scholar 

  15. Giordano A, Giuliano M, De Laurentiis M, et al. Circulating tumor cells in immunohistochemical subtypes of metastatic breast cancer: lack of prediction in HER2-positive disease treated with targeted therapy. Ann Oncol. 2012;23:1144–50.

    Article  CAS  PubMed  Google Scholar 

  16. Wallwiener M, Hartkopf AD, Baccelli I, et al. The prognostic impact of circulating tumor cells in subtypes of metastatic breast cancer. Breast Cancer Res Treat. 2013;137:503–10.

    Article  PubMed  Google Scholar 

  17. Budd GT, Cristofanilli M, Ellis MJ, et al. Circulating tumor cells vs imaging–predicting overall survival in metastatic breast cancer. Clin Cancer Res. 2006;12:6403–9.

    Article  CAS  PubMed  Google Scholar 

  18. De Giorgi U, Valero V, Rohren E, et al. Circulating tumor cells and bone metastases as detected by FDG-PET/CT in patients with metastatic breast cancer. Ann Oncol. 2010;21:33–9.

    Article  PubMed  Google Scholar 

  19. Hayes DF, Bast RC, Desch CE, et al. Tumor marker utility grading system: a framework to evaluate clinical utility of tumor markers. J Natl Cancer Inst. 1996;88:1456–66.

    Article  CAS  PubMed  Google Scholar 

  20. Harris L, Fritsche H, Mennel R, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2007;25:5287–312.

    Article  CAS  PubMed  Google Scholar 

  21. Hoefnagel LD, van de Vijver MJ, van Slooten HJ, et al. Receptor conversion in distant breast cancer metastases. Breast Cancer Res. 2010;12:R75.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Smerage JB, Barlow WE, Hayes DF, et al. SWOG S0500—a randomized phase III trial to test the strategy of changing therapy vs maintaining therapy for metastatic breast cancer patients who have elevated circulating tumor cell (CTC) levels at first follow-up assessment. Presented at San Antonio Breast Cancer Symposium, December, 2013. Clinical trial demonstrated that changing therapy based on earlier detection of elevated CTC count after therapy does not result in superior outcomes.

  23. Lindstrom LS, Karlsson E, Wilking UM, et al. Clinically used breast cancer markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 are unstable throughout tumor progression. J Clin Oncol. 2012;30:2601–8.

    Article  PubMed  Google Scholar 

  24. Riethdorf S, Muller V, Zhang L, et al. Detection and HER2 expression of circulating tumor cells: prospective monitoring in breast cancer patients treated in the neoadjuvant GeparQuattro trial. Clin Cancer Res. 2010;16:2634–45.

    Article  CAS  PubMed  Google Scholar 

  25. Sieuwerts AM, Mostert B, Bolt-de Vries J, et al. mRNA and microRNA expression profiles in circulating tumor cells and primary tumors of metastatic breast cancer patients. Clin Cancer Res. 2011;17:3600–18.

    Article  CAS  PubMed  Google Scholar 

  26. Somlo G, Lau SK, Frankel P, et al. Multiple biomarker expression on circulating tumor cells in comparison to tumor tissues from primary and metastatic sites in patients with locally advanced/inflammatory, and stage IV breast cancer, using a novel detection technology. Breast Cancer Res Treat. 2011;128:155–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Aktas B, Muller V, Tewes M, et al. Comparison of estrogen and progesterone receptor status of circulating tumor cells and the primary tumor in metastatic breast cancer patients. Gynecol Oncol. 2011;122:356–60.

    Article  CAS  PubMed  Google Scholar 

  28. Fehm T, Hoffmann O, Aktas B, et al. Detection and characterization of circulating tumor cells in blood of primary breast cancer patients by RT-PCR and comparison to status of bone marrow disseminated cells. Breast Cancer Res. 2009;11:R59.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hayes DF, Walker TM, Singh B, et al. Monitoring expression of HER-2 on circulating epithelial cells in patients with advanced breast cancer. Int J Oncol. 2002;21:1111–7.

    CAS  PubMed  Google Scholar 

  30. Wulfing P, Borchard J, Buerger H, et al. HER2-positive circulating tumor cells indicate poor clinical outcome in stage I to III breast cancer patients. Clin Cancer Res. 2006;12:1715–20.

    Article  PubMed  Google Scholar 

  31. Flores LM, Kindelberger DW, Ligon AH, et al. Improving the yield of circulating tumour cells facilitates molecular characterisation and recognition of discordant HER2 amplification in breast cancer. Br J Cancer. 2010;102:1495–502.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Tewes M, Aktas B, Welt A, et al. Molecular profiling and predictive value of circulating tumor cells in patients with metastatic breast cancer: an option for monitoring response to breast cancer related therapies. Breast Cancer Res Treat. 2009;115:581–90.

    Article  PubMed  Google Scholar 

  33. DETECT III - A multicenter, phase III study to compare standard therapy +/−lapatinib in HER2-ve MBC-patients with HER2+ve CTCs [database on the Internet]. Available at: http://clinicaltrials.gov/show/NCT01619111. Accessed Dec 30, 2013.

  34. Gallant JN, Matthew EM, Cheng H, Harouaka R, Lamparella NE, Kunkel M, et al. Predicting therapy response in live tumor cells isolated with the flexible micro spring array device. Cell Cycle. 2013;12:2132–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Hou HW, Warkiani ME, Khoo BL, et al. Isolation and retrieval of circulating tumor cells using centrifugal forces. Sci Rep. 2013;3:1259.

    CAS  PubMed Central  PubMed  Google Scholar 

  36. Ozkumur E, Shah AM, Ciciliano JC, et al. Inertial focusing for tumor antigen-dependent and -independent sorting of rare circulating tumor cells. Sci Transl Med. 2013;5, 179ra47.

    PubMed Central  PubMed  Google Scholar 

  37. Schneck H, Blassl C, Meier-Stiegen F, et al. Analysing the mutational status of PIK3CA in circulating tumor cells from metastatic breast cancer patients. Mol Oncol. 2013;7:976–86. This study reports a new method to molecularly characterize and identify actionable mutations in isolated CTCs.

    Article  CAS  PubMed  Google Scholar 

  38. Characterization of circulating tumor cells (CTCs) to direct pre-operative and systemic therapy in patients with locally advanced or metastatic stage IV breast cancer [database on the Internet]. Available at: http://clinicaltrials.gov/show/NCT01048918. Accessed Dec 30, 2013.

  39. Osborne CK, Pippen J, Jones SE, et al. Double-blind, randomized trial comparing the efficacy and tolerability of fulvestrant vs anastrozole in postmenopausal women with advanced breast cancer progressing on prior endocrine therapy: results of a North American trial. J Clin Oncol. 2002;20:3386–95.

    Article  CAS  PubMed  Google Scholar 

  40. Characterization of circulating tumor cells (CTC) from patients with metastatic breast cancer using the CTC-Endocrine Therapy Index (COMETI P2) [database on the Internet]. Available at: http://clinicaltrials.gov/show/NCT01701050. Accessed Jan 16, 2014.

  41. Krishnamurthy S, Cristofanilli M, Singh B, et al. Detection of minimal residual disease in blood and bone marrow in early stage breast cancer. Cancer. 2010;116:3330–7.

    Article  PubMed  Google Scholar 

  42. Lucci A, Hall CS, Lodhi AK, et al. Circulating tumour cells in non-metastatic breast cancer: a prospective study. Lancet Oncol. 2012;13:688–95.

    Article  PubMed  Google Scholar 

  43. Coumans FA, Siesling S, Terstappen LW. Detection of cancer before distant metastasis. BMC Cancer. 2013;13:283.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Fischer JC, Niederacher D, Topp SA, et al. Diagnostic leukapheresis enables reliable detection of circulating tumor cells of nonmetastatic cancer patients. Proc Natl Acad Sci U S A. 2013;110:16580–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Circulating tumor cells (CTCs): a potential screening test for clinically undetectable breast carcinoma [database on the Internet]. Available at: http://clinicaltrials.gov/show/NCT01322750. Accessed Dec 30, 2013.

  46. Nakagawa T, Martinez SR, Goto Y, et al. Detection of circulating tumor cells in early-stage breast cancer metastasis to axillary lymph nodes. Clin Cancer Res. 2007;13:4105–10.

    Article  CAS  PubMed  Google Scholar 

  47. Georgoulias V, Bozionelou V, Agelaki S, et al. Trastuzumab decreases the incidence of clinical relapses in patients with early breast cancer presenting chemotherapy-resistant CK-19mRNA-positive circulating tumor cells: results of a randomized phase II study. Ann Oncol. 2012;23:1744–50. This Phase-II study demonstrates the ability of trastuzumab to effectively eliminate HER2+ CTCs, in patients with HER2- primary tumors. Trastuzumab treated patients had a longer DFS and reduced number of relapses.

    Article  CAS  PubMed  Google Scholar 

  48. Efficacy study of Herceptin to treat HER2-negative CTC breast cancer (TREAT-CTC) [database on the Internet]. Available at: http://clinicaltrials.gov/show/NCT01548677. Accessed Dec 30, 2013.

  49. Zhang L, Ridgway LD, Wetzel MD, et al. The identification and characterization of breast cancer CTCs competent for brain metastasis. Sci Transl Med. 2013;5, 180ra48.

    PubMed  Google Scholar 

  50. Tiwari N, Gheldof A, Tatari M, Christofori G. EMT as the ultimate survival mechanism of cancer cells. Semin Cancer Biol. 2012;22:194–207.

    Article  CAS  PubMed  Google Scholar 

  51. Kasimir-Bauer S, Hoffmann O, Wallwiener D, Kimmig R, Fehm T. Expression of stem cell and epithelial-mesenchymal transition markers in primary breast cancer patients with circulating tumor cells. Breast Cancer Res. 2012;14:R15.

  52. Dawson SJ, Tsui DW, Murtaza M, et al. Analysis of circulating tumor DNA to monitor metastatic breast cancer. N Engl J Med. 2013;368:1199–209. This prospective study shows a higher sensitivity of detection of circulating tumor DNA in comparison to CTCs, in selected patients with specific mutations.

    Article  CAS  PubMed  Google Scholar 

  53. Higgins MJ, Jelovac D, Barnathan E, et al. Detection of tumor PIK3CA status in metastatic breast cancer using peripheral blood. Clin Cancer Res. 2012;18:3462–9. This study reports a novel technique to identify specific cancer mutations from a blood sample, by detecting circulating tumor DNA.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Sasmit Sarangi, Kailash Mosulpuria, Michaela J. Higgins, Aditya Bardia declare that they have no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Aditya Bardia.

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Sarangi, S., Mosalpuria, K., Higgins, M.J. et al. The Evolving Role of Circulating Tumor Cells in the Personalized Management of Breast Cancer: From Enumeration to Molecular Characterization. Curr Breast Cancer Rep 6, 146–153 (2014). https://doi.org/10.1007/s12609-014-0149-9

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  • DOI: https://doi.org/10.1007/s12609-014-0149-9

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