Liquid Biopsy: Implications for Cancer Staging & Therapy

Transcription

1 Prof. Klaus Pantel, MD, PhD Institut für Tumorbiologie Liquid Biopsy: Implications for Cancer Staging & Therapy

2 Tumor cell dissemination and cancer dormancy Primary tumor Local relapse Cancer cells disseminate early into the bone marrow and pose a risk for subsequent relapse (Braun/Pantel et al., NEJM, 2005; Köllermann/Pantel et al., J Clin Oncol., 2008) VCAM1 promotes osteoclast differentiation & activation & attracts osteoclast progenitors (Lu/Pantel/Kang et al Cancer Cell 2011) Tumor-Induced osteoclast mirna changes as regulators and biomarkers of osteolytic bone metastasis (Ell/Pantel/Kang et al, Cancer Cell 2013) Metabolic adaptation of DTCs is important for survival (LeBleu, Pantel, Kalluri et al, Nature Cell Biol. 2014) RAI2 as new metastasis-suppressor (Werner, Wikman, Wilmanns, Pantel et al, Cancer Discovery 2015) DTCs persist in the bone marrow through sustained activation of the unfolded protein response (Bartkowiak, Pantel et al., Cancer Res. 2015) Exosome-mediated homing of metastatic cells to specific distant sites (Hoshino, Pantel, Bissell, Peinado, Lyden et al., Nature, 2015) Blood Distant tissue (e.g. bone marrow) Recirculation Tumormass dormancy Micrometastasis Metastasis DTCs Escape CTCs DTC Tumor cell dormancy NATURE REVIEWS CLINICAL ONCOLOGY VOLUME 6 JUNE

3 2010

4 Anoikis resistance Epithelial-to-mesenchymal transition Invasion/Intravasation ability (single CTCs and/or clusters) Liquid phase of tumor progression Homing & metastasis-initiating potential The technical challenge: Phenotypic diversity Alix-Panabieres & Pantel, Nature Rev. Cancer 2014 Genomic heterogeneity Finding one tumor cell in normal blood cells

5 Biological properties Protein expression Positive Selection (a) anti-e markers Ab (E.g., EpCAM) CTC anti-e/m markers Ab (E.g., Plastin 3) Ex vivo anti-m markers Ab (E.g., N-Cadherin) CTC (c) - CellSearch system - MagSweeper - EPHESIA CTC-chip - CTC-chip - Velcro-like device In vivo - CellCollector - Photoacoustic nanodetector Physical properties Label-free strategies (d) (e) (f) DEP DEP CTC-iChip (g) Out Anti-CD45 Negative Selection (b) Anti-CD45 CTCs anti-e markers Ab WBC Alix-Panabieres & Pantel, Nature Rev. Cancer 2014 CTC WBC RBC

6 Size-based capture of CTCs (Parsortix TM ): Capture of EpCAM+ and EpCAM- CTCs Hvichia, Riethdorf, Wikman, Neves, Stöcklein, Pantel, Gorges et al. (Int J Cancer 2016)

7 New approach: In vivo capture of CTC Lung cancer CTCs: Gorges, Pantel et al., CCR 2016

8 Epithelial-Mesenchymal Plasticity of CTCs EpCAM, CK Intermediate E/M Phenotypes: Potential MICs! Individual cytokeratins can be downregulated pan-cytokeratin antibodies increase CTC assay sensitivity (Joosse, Pantel et al., Clin. Cancer Res. 2012) Vimentin CellSearch TM captures CTCs with very low EpCAM expression (L. Terstappen et al.) Plastin-3 as new CTC marker not downregulated during EMT (Yokobori, Mimori, Pantel, Mori et al. Cancer Res. Febr. 2013) Bednarz-Knoll, Alix-Panabières & Pantel Cancer & Met Rev 2012

9

10 CTC detection in early stage cancer: Identification of patients at high risk to develop metastasis who may need more intense adjuvant therapy

11 EpCAM+/CK+ CTCs are associated with unfavorable prognosis in early stage cancer Breast Cancer: Rack, Pantel, Janni et al, JNCI 2014 Bladder Cancer: Rink, Pantel et al, Eur. Urol. 2012; Gazzaniga, Pantel et al, Int J Cancer 2014 Head & Neck Cancer: Grobe, Riethdorf, Pantel et al., CCR 2014 Testicular Germ Cell Tumors: Nastaly, Riethdorf, Pantel et al., CCR 2014 Colorectal Cancer: Yokobori, Mimori, Mori, Pantel et al., Cancer Res. 2013

12 Prognostic impact of EpCAM+/CK+ CTC in breast cancer patients (n > 2000) without overt metastases 2016 Rack, Janni, Pantel > et 3000 al, JNCI Patients 2014

13 TNM 2010: CTC in new cm0(i+) Classification

14 CTCs in brain cancer patients: Challenge the paradigm that brain tumors do not disseminate via the blood

15 Hematogeneous spread of primary brain tumors: Detection of CTCs in glioma patients (~20%) GFAP stain Immunosuppressed recipients of organs transplanted from glioma patients can develop metastasis, while Single Cell isolation Single Cell CGH metastasis is very rare in glioma patients EGFR amplification Müller, Westphal, Pantel, Riethdorf et al., Science TM, 2014

16 Liquid Biopsy for metastatic patients Metastasis evolve many years after primary tumor resection and can harbor unique genomic alterations. Biopsy of metastases is an invasive and sometimes dangerous procedure. Intra-patient heterogeneity of metastases at different sites CTC/ctDNA might reveal representative information on metastatic cells located at different sites Alix-Panabières & Pantel, Clin Chem, 2013; Pantel & Alix- Panabieres, Cancer Res. 2013

17 Monitoring of CTCs: Can early changes in CTC counts predict the efficacy of therapeutic interventions (e.g., chemotherapy, hormonal therapy)?

18 centres provided data for 1944 eligible patients from 20 studies Meta-analysis on raw data.

19 CTCs vs. conventional tumor markers (PFS, p values) in metastatic breast cancer patients receiving chemotherapy CTCBL ( baseline 3-5 weeks 6-8 weeks Model used as reference CA15-3BL CEABL CTC3-5 CA15-3 BL + CA CEABL + CEA 3-5 CTC6-8 CA15-3 BL + CA CEABL + CEA 6-8 N patients CP 6 E CP +CTCBL CP +CTCBL + CTC3-5 CP +CTCBL + CTC E E Few events Few events Bidard, Pierga, Michels, Pantel et al, Lancet Oncology 2014, European Pooled Analysis of CTCs in metastatic BC (n=1944)