title: Sampling circulating tumor cells for clinical benefits: how frequent?
abstract: Circulating tumor cells (CTCs) are cells shed from tumors or metastatic sites and are a potential biomarker for cancer diagnosis, management, and prognostication. The majority of current studies use single or infrequent CTC sampling points. This strategy assumes that changes in CTC number, as well as phenotypic and molecular characteristics, are gradual with time. In reality, little is known today about the actual kinetics of CTC dissemination and phenotypic and molecular changes in the blood of cancer patients. Herein, we show, using clinical case studies and hypothetical simulation models, how sub-optimal CTC sampling may result in misleading observations with clinical consequences, by missing out on significant CTC spikes that occur in between sampling times. Initial studies using highly frequent CTC sampling are necessary to understand the dynamics of CTC dissemination and phenotypic and molecular changes in the blood of cancer patients. Such an improved understanding will enable an optimal, study-specific sampling frequency to be assigned to individual research studies and clinical trials and better inform practical clinical decisions on cancer management strategies for patient benefits.
authors.affiliation: Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Sai Mun
authors.initials: SM
authors.lastname: Leong
authors.affiliation: Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. karen_ml_tan@nuhs.edu.sg.
authors.forename: Karen M L
authors.initials: KM
authors.lastname: Tan
authors.affiliation: Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Hui Wen
authors.initials: HW
authors.lastname: Chua
authors.affiliation: Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore.
authors.forename: Doreen
authors.initials: D
authors.lastname: Tan
authors.affiliation: Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore.
authors.forename: Delly
authors.initials: D
authors.lastname: Fareda
authors.affiliation: Radlink PET and Cardiac Imaging Center, 290 Orchard Road, #08-06 Paragon Medical, Singapore, 238859, Singapore.
authors.forename: Saabry
authors.initials: S
authors.lastname: Osmany
authors.affiliation: CellSievo Private Limited Singapore, Block 289A, Bukit Batok St. 25, #15-218, Singapore, 650289, Singapore.
authors.forename: Mo-Huang
authors.initials: MH
authors.lastname: Li
authors.affiliation: Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore.
authors.forename: Steven
authors.initials: S
authors.lastname: Tucker
authors.affiliation: Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.|Department of Pathology, National University of Singapore, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Evelyn S C
authors.initials: ES
authors.lastname: Koay
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D009369:Neoplasms / Q000378:metabolism*; D009360:Neoplastic Cells, Circulating / Q000378:metabolism* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor