FEATURE


EDITORIAL


Using circulating tumor cells to guide therapy in breast cancer: could this replace biopsies?


Editorial in Pharmacogenomics By Shaheenah Dawood & Massimo Cristofanilli


Over the last two decades we have seen a number of important advances in the biological underpinnings of breast cancer that have had a significant impact either directly or indirectly on the management and ultimately on the prognostic outcome of this disease. First, we now know that breast cancer is a heterogeneous disease made up of a number of unique subtypes each with its own natural history and associated prognostic outcome [1]. Second, some of these subtypes have specific targets (including ER and HER2) that have associated unique targeted therapeutic agents that significantly impact the natural history of this disease [2]. Third, data indicate that these targets are not static with approximately 30% of tumors showing discordance in the expression of hormone receptor or HER2 between the primary and associated metastatic tumor [3]. The therapeutic implications of such discordance have


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Over the last decade we have seen data reported from a number of important studies that looked at the prognostic and predictive role of circulating tumor cells in both early stage and metastatic breast cancer.


understandably resulted in most oncologists seeking to biopsy metastatic sites whenever possible. Despite these advances we have a long way to go with current research focusing on looking for biomarkers that have a dual prognostic and predictive function. An ideal biomarker being one able to accurately predict for early recurrence or progression of disease, provide information to guide therapeutic decisions, reliably predict response to specific treatment, provide an easy platform for testing of markers such as ER and HER2 at various time points along a cancer history continuum, and allow for the identification of unique targets that would help specific drug development. Circulating tumor cells (CTCs) is one such biomarker that has been actively investigated over the last decade


and has shown promising results in a number of malignancies including breast cancer. The presence of epithelial cells in the circulation that are similar in appearance to primary tumor cells was first described


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