Circulating tumour cell gene expression and chemosensitivity analyses: predictive accuracy for response to multidisciplinary treatment of patients with unresectable refractory recurrent rectal cancer or unresectable refractory colorectal cancer liver metastases
Stefano Guadagni,
Francesco Masedu,
Giammaria Fiorentini,
Donatella Sarti,
Caterina Fiorentini,
Veronica Guadagni,
Panagiotis Apostolou,
Ioannis Papasotiriou,
Panagiotis Parsonidis,
Marco Valenti,
Enrico Ricevuto,
Gemma Bruera,
Antonietta R. Farina,
Andrew R. Mackay,
Marco Clementi
Affiliations
Stefano Guadagni
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Francesco Masedu
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Giammaria Fiorentini
Department of Oncology and Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”
Donatella Sarti
Department of Oncology and Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”
Caterina Fiorentini
Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich
Veronica Guadagni
Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary
Panagiotis Apostolou
Research Genetic Cancer Centre S.A
Ioannis Papasotiriou
Research Genetic Cancer Centre International GmbH
Panagiotis Parsonidis
Research Genetic Cancer Centre S.A
Marco Valenti
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Enrico Ricevuto
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Gemma Bruera
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Antonietta R. Farina
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Andrew R. Mackay
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Marco Clementi
Department of Applied Clinical and Biotechnological Sciences, University of L’Aquila
Abstract Background Patients with unresectable recurrent rectal cancer (RRC) or colorectal cancer (CRC) with liver metastases, refractory to at least two lines of traditional systemic therapy, may receive third line intraarterial chemotherapy (IC) and targeted therapy (TT) using drugs selected by chemosensitivity and tumor gene expression analyses of liquid biopsy-derived circulating tumor cells (CTCs). Methods In this retrospective study, 36 patients with refractory unresectable RRC or refractory unresectable CRC liver metastases were submitted for IC and TT with agents selected by precision oncotherapy chemosensitivity assays performed on liquid biopsy-derived CTCs, transiently cultured in vitro, and by tumor gene expression in the same CTC population, as a ratio to tumor gene expression in peripheral mononuclear blood cells (PMBCs) from the same individual. The endpoint was to evaluate the predictive accuracy of a specific liquid biopsy precision oncotherapy CTC purification and in vitro culture methodology for a positive RECIST 1.1 response to the therapy selected. Results Our analyses resulted in evaluations of 94.12% (95% CI 0.71–0.99) for sensitivity, 5.26% (95% CI 0.01–0.26) for specificity, a predictive value of 47.06% (95% CI 0.29–0.65) for a positive response, a predictive value of 50% (95% CI 0.01–0.98) for a negative response, with an overall calculated predictive accuracy of 47.22% (95% CI 0.30–0.64). Conclusions This is the first reported estimation of predictive accuracy derived from combining chemosensitivity and tumor gene expression analyses on liquid biopsy-derived CTCs, transiently cultured in vitro which, despite limitations, represents a baseline and benchmark which we envisage will be improve upon by methodological and technological advances and future clinical trials.
