Using circulating tumor cells to advance precision medicine in prostate cancer

The field of circulating tumor cell(CTC)enrichment has seen many emerging technologies in recent years,which have resulted in the identification and monitoring of clinically relevant,CTC-based biomarkers that can be analyzed routinely without invasive procedures.Several molecular platforms have been used to investigate the molecular profile of the disease,from high throughput gene expression analyses down to single cell biological dissection.The established presence of CTC heterogeneity nevertheless constitutes a challenge for cell isolation as the several subpopulations can potentially display different molecular characteristics;in this scenario,careful consideration must be given to the isolation approach,whereas methods that discriminate against certain subpopulations may result in the exclusion of CTCs that carry biological relevance.In the context of prostate cancer,CTC molecular interrogation can enable longitudinal monitoring of key biological features during treatment with substantial clinical impact,as several biomarkers could predict tumor response to AR signaling inhibitors(abiraterone,enzalutamide)or standard chemotherapy(taxanes).Thus,CTCs represent a valuable opportunity to personalize medicine in current clinical practice.

Quantitative analysis of taxane drug target engagement of microtubules in circulating tumor cells from metastatic castration resistant prostate cancer patients treated with CRXL301,a nanoparticle of docetaxel

Aim:We reviewed the radiographic response of three patients with metastatic castration-resistant prostate cancer treated with CRXL301,a docetaxel nanoparticle.For these three patients,we isolated and analyzed circulating tumor cells(CTCs)to explore microtubule(MT)drug-target engagement(MT-DTE)as a biomarker of response to treatment.MT-DTE was based on a quantitative assessment of the MT cytoskeleton in CTCs from pre-and posttreatment patient samples as a potential read-out of CRXL301 activity.Methods:We isolated CTCs using negative CD45+depletion and subjected them to multiplex confocal microscopy using our established protocol.CTCs were identified as CD45-/CK+/DAPI+cells and MT-DTE was determined using our developed imaging algorithm.We quantified MT bundling in CTCs across multiple time points,from baseline to on-treatment to disease progression.Here,we describe the longitudinal analysis of MT-DTE in CTCs from patients treated with CRXL301 and its correlation with response to treatment.Results:We collected CTCs at seven time points from three metastatic castration-resistant prostate cancer patients.Clinical response was evaluated by Response Evaluation Criteria in Solid Tumors(RECIST)v.1.1 criteria in those patients with measurable disease.Of the three patients enrolled,one experienced partial response(-50%)to CRXL301 and two patients were unevaluable given bone only disease.Notably,however,these two patients showed stable disease clinically based on bone scans.MT-DTE across all time points revealed that,early time points within four and 24 h of drug administration exhibited the highest levels of drug engagement(MT-DTE)as compared to baseline.However,these early time points did not correlate with clinical response.We observed that the CTCs collected one week after the first or second dose of CRXL301 treatment in the responding patient had numerically higher levels of MT-DTE as compared to the other two patients.Conclusion:Taxane on-target activity can be detected and analyzed quantitatively in CTCs by tubulin immunofluorescence.Early time points,within 24 h of drug administration,showed high levels of DTE but did not correlate with clinical response.MT-DTE in CTCs collected after one week on treatment correlated best with treatment response.The clinical utility of the 1-week CTC DTE should be tested and validated in future clinical trials involving taxanes.