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Review
. 2021 Jun;15(6):1647-1666.
doi: 10.1002/1878-0261.12869. Epub 2020 Dec 25.

Clinical utility of circulating tumor cells: an update

Antoine Vasseur  1 , Nicolas Kiavue  1 , François-Clément Bidard  1   2   3 , Jean-Yves Pierga  1   3   4 , Luc Cabel  1   3
Affiliations
Review

Clinical utility of circulating tumor cells: an update

Antoine Vasseur et al. Mol Oncol. 2021 Jun.

Abstract

The prognostic role of circulating tumor cells (CTCs) has been clearly demonstrated in many types of cancer. However, their roles in diagnostic and treatment strategies remain to be defined. In this review, we present an overview of the current clinical validity of CTCs in nonmetastatic and metastatic cancer, and the main studies or concepts investigating the clinical utility of CTCs. In particular, we focus on breast, lung, colorectal, and prostate cancer. Two major topics concerning the clinical utility of CTC are discussed: treatment based on CTC count or CTC variations, and treatment based on the molecular characteristics of CTCs. Although some of these studies are inconclusive, many are still ongoing, and their results could help to define the role of CTCs in the management of cancers. A summary of published or ongoing phase II-III trials is also presented.

Keywords: CTC-derived xenografts; circulating tumor cells; clinical utility; clinical validity; liquid biopsy.

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Conflict of interest statement

FCB and JYP report research grants from Menarini Silicon Biosystems and FCB reports travel support from Menarini Silicon Biosystems. Other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Circulating tumor cells could improve the management of cancers in several ways. Using the prognostic value of the CTC count or of the CTC fluctuations could allow for the treatment intensification in patients with a poor prognosis or de‐escalation in patients with a good prognosis. It could also serve as an endpoint to evaluate the efficacy of a treatment. Molecular characteristics of CTCs could also be used for their theranostic value.
Figure 2
Figure 2
Future application for CTCs. Culture of CTCs could assist in real‐time treatment testing, and CTCs from a patient may be isolated and grafted into mice as CTC‐derived xenografts (CDX), generating a patient‐specific model for drug testing, identification of resistance mechanisms and biomarker development. Genomic, transcriptomic and proteomic analysis of single/bulk CTCs allows evaluation of tumor heterogeneity and evolution during treatment.
See this image and copyright information in PMC

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