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Galletti et al. J Cancer Metastasis Treat 2017;3:190-205 Journal of
DOI: 10.20517/2394-4722.2017.45
Cancer Metastasis and Treatment

www.jcmtjournal.com
Review Open Access

Using circulating tumor cells to advance

precision medicine in prostate cancer

Giuseppe Galletti 1,2* , Daniel Worroll 1,2* , David M. Nanus , Paraskevi Giannakakou 1,2
1,2
1 Department of Medicine, Hematology and Oncology, Weill Cornell Medicine, New York, NY 10065, USA.
2 Sandra and Edward Meyer Cancer Center, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
*The first two authors contributed equally to the work.

Correspondence to: Dr. Giuseppe Galletti, Department of Medicine, Hematology and Oncology, Weill Cornell Medicine, 1300 York Avenue, New
York, NY 10065, USA. E-mail: gig2002@med.cornell.edu

How to cite this article: Galletti G, Worroll D, Nanus DM, Giannakakou P. Using circulating tumor cells to advance precision medicine in prostate
cancer. J Cancer Metastasis Treat 2017;3:190-205.
ABSTRACT
Article history: The field of circulating tumor cell (CTC) enrichment has seen many emerging technologies
Received: 21 Jun 2017 in recent years, which have resulted in the identification and monitoring of clinically
Accepted: 30 Aug 2017 relevant, CTC-based biomarkers that can be analyzed routinely without invasive procedures.
Published: 27 Sep 2017 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
Key words: dissection. The established presence of CTC heterogeneity nevertheless constitutes a
Circulating tumor cells, challenge for cell isolation as the several subpopulations can potentially display different
liquid biopsy, molecular characteristics; in this scenario, careful consideration must be given to the
prostate cancer, isolation approach, whereas methods that discriminate against certain subpopulations may
precision medicine, result in the exclusion of CTCs that carry biological relevance. In the context of prostate
predictive biomarkers, cancer, CTC molecular interrogation can enable longitudinal monitoring of key biological
targeted therapy 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.

INTRODUCTION of drug resistance, which remains a major clinical
challenge. Moreover, we are yet unable to predict
Recent advances in the treatment of metastatic response to a specific therapy in an individual patient
prostate cancer (PC) led to the FDA-approval of and the optimal sequence of these therapies needs to
many effective therapies (abiraterone acetate, be clarified. The results of two large phase III clinical
enzalutamide, radium-223), which demonstrated a trials (STAMPEDE trial and CHAARTED trial) support
significant survival benefit for patients with castrate the use of taxane chemotherapy in combination with
resistant PC [1,2] . Nevertheless, patients’ clinical standard androgen deprivation therapy (ADT) in
response is only transient, owing to the development patients with hormone-sensitive metastatic PC [3,4] .

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