Dr purvish m parikh md dnb ficp phd ecmo cpi mba purvish1@gmail com
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Circulating Tumor Cells PowerPoint PPT Presentation

Describes the importance of liquid biopsy and circulating tumor cells enumeration as a marker of predictive and prognostic value in cancer treatment

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Circulating Tumor Cells

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Dr purvish m parikh md dnb ficp phd ecmo cpi mba purvish1@gmail com

Circulating Tumor Cells

Dr Purvish M ParikhMD, DNB, FICP, PhD, ECMO, CPI, [email protected]

9th SAARC Federation of Oncologists’ Conference

Director of Precision Oncology & Research, Asian Institute of Oncology,

Sion, Mumbai

Circulating tumor cells ctc

Circulating Tumor Cells (CTC)

  • Cristofanilli M et al: CTC, disease progression, and survival in MBC. NEJM 2004; 351: 781-791

  • Google search - 9,11,000 hits

  • Medline Search – 15,272 publications

    706 so far in 2014

  • Kim H et al: Development of On-Chip Multi-Imaging Flow Cytometry for Identification of Imaging Biomarkers of Clustered CTC. PLoS One. 2014 Aug 20;9(8):e104372.

Circulating tumor cells liquid biopsy

Circulating Tumor Cells – Liquid biopsy

Assay uses 15 ml peripheral whole blood for CTC of epithelial origin for:

  • detection,

  • enrichment and

  • quantification .

  • Predict progression free survival (PFS) and overall survival (OS)

    2. Monitor response to therapy

Circulating tumor cells

CTC – Concept

Ctc identification

CTC - identification

  • Nucleated cells (DAPI+)

  • Expressing CK (cytokeratin) in cytoplasm, and EpCAM (epithelial cell adhesion molecule) on cell surface

  • Using immunofluorescent reagents.

CTC images courtesy : Datar Genetics, Mumbai, India

Ctc identification1

CTC - identification

CTC images courtesy : Datar Genetics, Mumbai, India

Green – cytokeratin (CK)

Composite staining showing all three features

Blue – DAPI (Nucleus)

Red – EpCAM

Ctc cut off levels

CTC – cut off levels

5 CTCs/7.5 mL blood:

  • Metastatic breast cancer

  • Metastatic prostate cancer

    3 CTCs/7.5 mL blood:

  • Metastatic colorectal cancer

Ctc predictive value

CTC – Predictive Value

Ctc monitoring rx efficacy

CTC – Monitoring Rx efficacy

  • Predict treatment response earlier (3-4 weeks) than imaging (8-12 weeks) after initiation of therapy.

  • Accurate indicator of rapid disease progression and shorter survival.

Ctc additional application

CTC – additional application

  • Captured CTCs can be used for molecular profiling studies (DNA, RNA) including FISH, array based methodologies, and cellular phenotyping (PSA, HER-2/neu or EGFR )

  • Also has application in cancers of urinary bladder, biliary duct, liver, pancreas and lung.

Circulating tumor cells

CTC – quantitative vital cells

Circulating tumor cells

CTC – in vitro chemosensitivity (1)

Circulating tumor cells

CTC – in vitro chemosensitivity (2)

Results within 9 hours

Role of molecular testing

Role of Molecular Testing

Exists at every stage of the cancer

  • Correct diagnosis

  • Prognostic and predictive value

  • Selecting

    • Most effective drug / combination

    • High risk patients for additional Rx

    • Early detection of recurrence

    • Preventing unwanted drug toxicity

  • Screening - family history of cancer

Circulating tumor cells

Remember …..Teamwork

is everything

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