Dr Kutikov

Cancer Therapy Advisor: Are CTC tests likely to become diagnostic tools in prostate cancer — or do early-stage tumors shed too few CTCs for reliable detection?

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Dr Kutikov: CTC testing harbors tremendous promise, though it is currently in its infancy. These cells are extremely rare, especially in patients with indolent tumors such as localized prostate cancer.

Only time will tell whether this technology will be applicable for detection/risk stratification of men with localized prostate malignancy. 

Cancer Therapy Advisor: What are the most near-term clinical applications of CTC testing? (Identifying aggressive genomics or phenotypes? Monitoring tumor evolution and the emergence of drug resistance? Predicting or detecting metastasis?)

Dr Kutikov: Using CTCs as a biomarker to assess disease progression and drug resistance is likely the “lowest hanging” fruit, though currently true clinical utility, in my opinion, is yet to be demonstrated. 

Cancer Therapy Advisor: What is the best CTC capture technology — or is there a clearly superior technology? Are cross-platform CTC tests a realistic goal?

Dr Kutikov:  Numerous platforms exists. As for any complex novel and often proprietary set of technologies the landscape is ever-shifting and is quickly disrupted by new innovations.

Cancer Therapy Advisor: Many assays rely on CTC enumeration — counting tumor cells. But what are the emerging roles of phenotypic or morphologic — or genomic — analyses in CTC testing? 

Dr Kutikov: Identifying prostate cancer subtypes that are resistant to standard therapies (eg, neuroendocrine tumors that are resistant to ADT [androgen deprivation therapy]) has been shown to be feasible. These type of diagnostic opportunities are quite exciting.

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Cancer Therapy Advisor: What about the timing of CTC sampling? Is it “one size fits all” or should timing vary with the intensity of treatment or the stage or aggressiveness of a patient’s cancer?

Dr Kutikov:  All of these questions are yet to be answered. The key questions are where during the arc of the disease course CTC sampling (1) provides reliable and meaningful data and (2) whether these data are actionable.