Abstract
Despite efforts to improve earlier diagnosis of non-small cell lung cancer (NSCLC), most patients present with advanced stage disease, which is often associated with poor survival outcomes with only 15% surviving for 5 years from their diagnosis. Tumour tissue biopsy is the current mainstream for cancer diagnosis and prognosis in many parts of the world. However, due to tumour heterogeneity and accessibility issues, liquid biopsy is emerging as a game changer for both cancer diagnosis and prognosis. Liquid biopsy is the analysis of tumour-derived biomarkers in body fluids, which has remarkable advantages over the use of traditional tumour biopsy. Circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) are two main derivatives of liquid biopsy. CTC enumeration and molecular analysis enable monitoring of cancer progression, recurrence, and treatment response earlier than traditional biopsy through a minimally invasive liquid biopsy approach. CTC-derived ex-vivo cultures are essential to understanding CTC biology and their role in metastasis, provide a means for personalized drug testing, and guide treatment selection. Just like CTCs, ctDNA provides opportunity for screening, monitoring, treatment evaluation, and disease surveillance. We present an updated review highlighting the prognostic and therapeutic significance of CTCs and ctDNA in NSCLC.
Highlights
Lung cancer is currently the most common cause of cancerrelated death worldwide [1] with a total of 1.80 million deaths in 2020 [2]
80% of lung cancer patients are diagnosed with non-small cell lung cancer (NSCLC), with only 15% surviving for 5 years [3, 4]
This study identified the presence of chronic obstructive pulmonary disease (COPD) as an independent risk factor (2–4 times higher in COPD patients than those without COPD) for lung cancer development in patients without clinically detectable lung cancer
Summary
Lung cancer is currently the most common cause of cancerrelated death worldwide [1] with a total of 1.80 million deaths in 2020 [2]. Frick et al in 2020 utilized a novel telomerase-based CTC assay and found that patients with elevated counts of CTCs prior to the start of stereotactic body radiotherapy (SBRT), as well as those patients whose CTCs remained persistently detectable after SBRT, were associated with increased regional and distant recurrence Use of this CTC assay may translate clinically by helping to identify subsets of patients who may maximally benefit from systemic therapy after SBRT for early-stage NSCLC, and to help monitor for tumour recurrence or progression [61]. A study by Duan and colleagues used CTC as a prognostic biomarker to discriminate benign vs malignant nodules as a means of early diagnosing lung cancer They used a group of 44 patients and subcategorized them based on their pathological results and found CTC detection rates to be increased with the invasiveness of the nodules.
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