In the May issue of CAP TODAY, Minetta Liu, M.D., of the Department of Medical Oncology and the Department of Laboratory Medicine and Pathology at Mayo Clinic discusses the use of circulating tumor cell (CTC) enumeration in her clinical practice.
The article, "Unraveling Metastasis With Circulating Tumor Cells," analyzes the mystery of cancer tumorigenesis and its deadly sequel, metastasis. CTCs are one of the keys to metastasis, which leave the primary tumor, travel through the body’s vasculature, and somehow serve as seeds for cancer’s spread.
“The prognostic value of CTC enumeration is repeatedly demonstrated with each reported clinical trial in metastatic breast or prostate cancer,” Dr. Liu says. “Those patients with elevated CTCs are much more likely to have inferior outcomes compared to patients with undetectable levels or low numbers. The questions are: How can we take advantage of this information, convert those patients with unfavorable to favorable CTC counts, and improve overall survival?”
According to Dr. Lui, CTCs are reflective of underlying tumor biology. She says, “In my clinical practice, I use serial CTC enumeration by the FDA-cleared technology as an adjunct to routine bloodwork, clinical evaluations, and imaging studies. In my laboratory research efforts, we are focused on the molecular characterization of CTCs by various platforms, with the goal of establishing CTC analyses as reliable predictors of treatment benefit to specific agents.”
While there has not yet been widespread uptake of CTCs in clinical practice, Dr. Lui believes "physicians are really looking beyond enumeration and prognosis toward using CTCs as a means of guiding drug selection and improving survival.”