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Title Optimization of the Enrichment of Circulating Tumor Cells for Downstream Phenotypic Analysis in Patients with Non-Small Cell Lung Cancer Treated with Anti-PD-1 Immunotherapy
Author Papadaki, Maria A.
Author Sotiriou, Afroditi I.
Author Vasilopoulou, Christina
Author Filika, Maria
Author Aggouraki, Despoina
Author Tsoulfas, Panormitis G.
Author Apostolopoulou, Christina A.
Author Rounis, Konstantinos
Author Mavroudis, Dimitrios
Author Agelaki, Sofia
Abstract The current study aimed at the optimization of circulating tumor cell (CTC) enrichment for downstream protein expression analyses in non-small cell lung cancer (NSCLC) to serve as a tool for the investigation of immune checkpoints in real time. Different enrichment approaches—ficoll density, erythrolysis, their combination with magnetic separation, ISET, and Parsortix—were compared in spiking experiments using the A549, H1975, and SKMES-1 NSCLC cell lines. The most efficient methods were tested in patients (n = 15) receiving immunotherapy targeting programmed cell death-1 (PD-1). Samples were immunofluorescently stained for a) cytokeratins (CK)/epithelial cell adhesion molecule (EpCAM)/leukocyte common antigen (CD45), and b) CK/programmed cell death ligand-1 (PD-L1)/ indoleamine-2,3-dioxygenase (IDO). Ficoll, ISET, and Parsortix presented the highest yields and compatibility with phenotypic analysis; however, at the patient level, they provided discordant CTC positivity (13%, 33%, and 60% of patients, respectively) and enriched for distinct CTC populations. IDO and PD-L1 were expressed in 44% and 33% and co-expressed in 19% of CTCs. CTC detection was associated with progressive disease (PD) (p = 0.006), reduced progression-free survival PFS (p = 0.007), and increased risk of relapse (hazard ratio; HR: 10.733; p = 0.026). IDO-positive CTCs were associated with shorter PFS (p = 0.039) and overall survival OS (p = 0.021) and increased risk of death (HR: 5.462; p = 0.039). The current study indicates that CTC analysis according to distinct immune checkpoints is feasible and may provide valuable biomarkers to monitor NSCLC patients treated with anti-PD-1 agents.
Language English
Subject CTCs
Circulating tumor cells
Immune checkpoint inhibitors
Immune evasion
Liquid biopsy
Non-small cell lung cancer
Programmed cell death-1 ligand
Issue date 2020-06-12
Collection   School/Department--School of Medicine--Department of Medicine--Publications
  Type of Work--Publications
Notes European Commission Horizon 2020-Research and Innovation Program H2020-FETOPEN-1-2016-2017 (GA NUMBER-737212-Capturing non-Amplified Tumor Circulating DNA with Ultrasound Hydrodynamics (CATCH-U-DNA)).
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