Abstract

Impact of Circulating Tumor Cells Heterogeneity for Monitoring Cancer Immunotherapy Effectiveness and Clinical Outcomes

Shibichakravarthy Kannan, Founder & CEO, Theranosis Life Sciences Pvt Ltd

Microfluidics based Lab-on-a-chip (LOC) technology has shown promise to study the circulating tumor cells (CTCs) in the peripheral blood of cancer patients. Detection and enumeration of CTCs over the course of cancer treatment (both chemotherapy and immunotherapy) has significant potential for implementing a precision medicine approach in cancer treatments. While tumor heterogeneity is a widely studied and well understood phenomenon the same is not true for circulating tumor cells. Recent reports have thrown some insights into the complexities of CTC heterogeneity and how this can influence our decision-making process while interpreting data from biofluid biopsies. CTC clusters are more likely to become secondary tumors compared to single cell CTCs. They can be treated as rogue clones of invasive cancer cells that are resistant to many conventional chemotherapy drugs. A combination of chemo and immunotherapy approach is the proposed solution to tackle the CTC clusters from surviving in the peripheral blood even before they have a chance to find a niche organ (with the right kind of tumor microenvironment) to settle down and grow into a secondary tumor. This is the holy grail of biofluid biopsy and we will cover some of the challenges in this domain and what is in store for the future of cancer treatment and treatment monitoring.