Liquid biopsy in ovarian cancer: the potential of circulating miRNAs and exosomes

Abstract

Ovarian cancer still remains the most lethal female cancer, since in most cases it is diagnosed at an advanced stage. Usually after completion of primary treatment chemoresistance occurs, and recurrent disease is finally observed. Liquid biopsy, based on minimally invasive and serial blood tests, has the advantage of following tumor evolution in real time, offering novel insights on precision medicine. Circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), circulating cell-free microRNAs (cfmiRNAs) and circulating exosomes represent the major components of liquid biopsy analysis. Liquid biopsy has been already implemented in ovarian cancer, and most studies so far are mainly focused on CTCs and ctDNA. This review is mainly focused on the clinical potential of circulating miRNAs and exosomes as a source of liquid biopsy biomarkers in ovarian cancer diagnosis, prognosis, and response to treatment.

Keywords: AUC = area under curve; CNV = copy number variations; CTCs = circulating tumor cells; EMT = epithelial-to-mesenchymal transition; EVs = extracellular vesicles; HGSC = high-grade serous ovarian cancer; LOH = loss of heterozygosity; NGS = next-generation sequencing; OS = overall survival; PARP = poly ADP-ribose polymerase; PFS = progression-free survival; ROC = receiver operating characteristic; cfDNA = cell-free DNA; cfmiRNAs = cell-free microRNAs; ctDNA = circulating tumor DNA; ddPCR = droplet digital PCR; snRNA = small nuclear RNA.