Abstract
Immunocytochemical or molecular assays allow the detection of single disseminated tumor cells (DTCs) in the bone marrow (BM) or the peripheral blood in 10% to 60% of breast cancer patients without signs of metastasis. Results from recently reported studies suggest that circulating tumor cell (CTC) levels may serve as a prognostic marker and be used for early assessment of therapeutic response in patients with metastatic breast cancer. In early stage breast cancer, however, the impact of CTCs is less well established than that of DTCs in BM, where several clinical studies demonstrated that such cells are an independent prognostic factor at primary diagnosis. The characterization of DTCs/CTCs has already shed new light on the complex process underlying early tumor cell dissemination and metastatic progression in cancer patients. Characterization of DTCs should help to identify novel targets for biological therapies aimed to prevent metastatic relapse. In addition, understanding tumor 'dormancy' and identifying metastatic stem cells might result in the development of new therapeutic concepts.
Highlights
Spread of tumor cells usually remains undetected in breast cancer patients even by conventional histopathological analysis and high-resolution imaging technologies
Clearance of disseminated tumor cells (DTCs) from bone marrow (BM) and/or tumor cells circulating in the blood could serve as an intermediate endpoint in clinical trials with anticancer agents
Examples of studies examining the prognostic relevance of disseminated tumor cells identified by immunocytochemistry in bone marrow of breast cancer patients without overt distant metastases
Summary
Spread of tumor cells usually remains undetected in breast cancer patients even by conventional histopathological analysis and high-resolution imaging technologies. Detection of disseminated tumor cells (DTCs) might help to identify patients in need of additional systemic therapies after successful surgical resection of the primary tumor. Circulating tumor cells (CTCs) were detected in approximately 70% of metastatic breast cancer patients.
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