MedicalResearch.com Interview with:
Dr. Sunitha Nagrath, PhD
Associate Professor, Chemical Engineering
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Lung cancer is leading cause of cancer-related mortality, and detecting it in earlier stages is crucial to improving outcomes for patients. The motivation for this study lies in understanding the phenotypic and genetic make-up of lung cancer during its early stages, using a blood sample (blood biopsy). We have done this by employing a microfluidic device to capture cancer cells circulating in the blood that is obtained from the peripheral veins and the pulmonary vein (a vein next to the tumor itself) from patients with early stage lung cancers. The idea behind using blood from the pulmonary vein was to obtain a richer yield of these circulating tumor cells, which are rare in the blood.
Through this study, we found that the pulmonary vein does yield a much higher quantity of circulating tumor cells, and also often harbors these cells in large clusters. We further went on to study the significance of these clusters, and found that these clusters indicated aggressive traits such as resistance to treatment, and could also potentially suggest poorer patient outcomes at long term.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Our study indicates that while tumor resection is universally considered a curative strategy for early stage lung cancers, the circulating tumor cells that have already been shed into the bloodstream could still be potentially lethal, as they could seed new tumors at distant sites, or contribute to tumor recurrence. There may hence be a future need to combine resections with a therapeutic strategy that eliminates the circulating tumor cells also.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future studies should look into molecular characterization of the CTCs, in order to determine molecular targets for effectively killing these cells in circulation. Such targets could eventually lead to ‘personalized medicine approach’ wherein every patient undergoing tumor resection could have his/her CTCs assessed for targeted therapy, so as to avoid the higher toxic side-effects of chemotherapy that is sometimes administered post-surgery.
Another important future step lies in finding the clonal constitution of the pulmonary vein and peripheral vein CTCs to determine what traits truly lead some of these cells to survive the shear stress in circulation and others to not. This will answer important questions regarding which cells are the aggressive survivors.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Vasudha Murlidhar, Rishindra M Reddy, Shamileh Fouladdel, Lili Zhao, Martin K. Ishikawa, Svetlana Grabauskiene, Zhuo Zhang, Jules Lin, Andrew C. Chang, Philip W Carrott, William R Lynch, Mark B. Orringer, Chandan Kumar-Sinha, Nallasivam Palanisamy, David G. Beer, Max S. Wicha, Nithya Ramnath, Ebrahim Azizi, Sunitha Nagrath. Poor Prognosis Indicated by Venous Circulating Tumor Cell Clusters in Early Stage Lung Cancers. Cancer Research, 2017; canres.2072.2016 DOI: 10.1158/0008-5472.CAN-16-2072
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