Abstract
Most breast cancer patients die due to metastases, and the early onset of this multistep process is usually missed by current tumor staging modalities. Therefore, ultrasensitive techniques have been developed to enable the enrichment, detection, isolation and characterization of disseminated tumor cells in bone marrow and circulating tumor cells in the peripheral blood of cancer patients. There is increasing evidence that the presence of these cells is associated with an unfavorable prognosis related to metastatic progression in the bone and other organs. This review focuses on investigations regarding the biology and clinical relevance of circulating tumor cells in breast cancer.
Highlights
Detection of circulating tumor cells (CTCs) in peripheral blood and disseminated tumor cells (DTCs) in bone marrow of tumor patients has become an active area of translational cancer research, with numerous groups developing new diagnostic assays and more than 200 clinical trials incorporating CTC counts as a biomarker in patients with various types of solid tumors
The still ongoing German ‘SUCCESS’ trial, which has enrolled almost 1,500 lymph node-positive and high-risk lymph nodenegative but metastasis-free breast cancer patients before and after taxane-based adjuvant therapy, defined that at least one CTC was evident in 10% of the patients at the time of primary diagnosis before adjuvant therapy, and a significantly better prognosis was detected in the groups with persistently negative CTC status [20]
In the ‘GEPARQuattro’ trial, which included 213 non-metastatic breast cancer patients, the prevalence of CTC-positive patients dropped from 22% before to 11% after neo-adjuvant therapy and again no associations were found with primary tumor response [26]
Summary
Detection of circulating tumor cells (CTCs) in peripheral blood and disseminated tumor cells (DTCs) in bone marrow of tumor patients has become an active area of translational cancer research, with numerous groups developing new diagnostic assays and more than 200 clinical trials incorporating CTC counts as a biomarker in patients with various types of solid tumors. Clinical utility of circulating tumor cells as a prognostic marker CTC detection is possible at both early and late stages of cancer development and might allow estimation of the risk of relapse and survival.
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