Abstract
Current developments in the treatment of genitourinary tumors underline the unmet clinical need for biomarkers to improve decision-making in a challenging clinical setting. The detection of circulating tumor cells (CTCs) has become one of the most exciting and important new approaches to identifying biomarkers at different stages of disease in a non-invasive way. Potential applications of CTCs include monitoring treatment efficacy and early detection of progression, selecting tailored therapies, as well as saving treatment costs. However, despite the promising implementation of CTCs in a clinical scenario, the isolation and characterization of these cells for molecular studies remain expensive with contemporary platforms, and significant technical challenges still need to be overcome. This updated, critical review focuses on the state of CTCs in patients with genitourinary tumor with focus on prostate cancer, discussing technical issues, main clinical results and hypothesizing potential future perspectives in clinical scenarios.
Highlights
Promising improvements have been made in managing genitourinary cancers thanks to the discovery of emerging targets along with novel molecules, medical oncologists continue to suffer from the lack of valid tools for cancer diagnosis and treatment monitoring
We review the role of circulating tumor cells (CTCs) in prostate cancer (PCa), urothelial carcinoma (UC) and renal cell carcinoma (RCC), underlining the prognostic role and therapeutic impact of molecular pathways, discussing recent clinical data published in the last three years, and investigations currently in progress, with a focus on the strengths and weaknesses of clinical applicability of this approach
The authors demonstrated that a CTC count >5 per 7.5 mL of blood at any time during the course of disease was associated with poor outcome, was predictive of a shorter progression-free survival (PFS), and resulted in the strongest independent predictor of overall survival (OS), when matched to prostate specific antigen (PSA) changes after treatment [27]
Summary
Promising improvements have been made in managing genitourinary cancers thanks to the discovery of emerging targets along with novel molecules, medical oncologists continue to suffer from the lack of valid tools for cancer diagnosis and treatment monitoring. Under the umbrella of CTC category, detection of CTC clusters ( called circulating tumor microemboli (CTM) or mixed cells clusters) has aroused great interest in the research community They were identified more than two decades ago in colon cancer and prostate cancer patients [3,4]. After the recent introduction of immune checkpoint inhibitors (ICIs) in several solid tumors, current investigations are exploring relevant immune-based biomarkers with CTCs in patients affected by genitourinary malignancies during treatment with ICIs (NCT02978118) Based on these findings, we review the role of CTCs in prostate cancer (PCa), urothelial carcinoma (UC) and renal cell carcinoma (RCC), underlining the prognostic role and therapeutic impact of molecular pathways, discussing recent clinical data published in the last three years, and investigations currently in progress, with a focus on the strengths and weaknesses of clinical applicability of this approach. “genitourinary cancers”, “prostate cancer”, “bladder cancers”, “renal cell carcinoma”, “targeted therapies”, and “immune checkpoint inhibitors”
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