Clinical significance of circulating tumor cells and cell‐free DNA in pediatric rhabdomyosarcoma

• Published in: Molecular oncology 2022-05, Vol.16 (10), p.2071-2085
• Main Authors: Tombolan, Lucia, Rossi, Elisabetta, Binatti, Andrea, Zin, Angelica, Manicone, Mariangela, Facchinetti, Antonella, Lucchetta, Silvia, Affinita, Maria Carmen, Bonvini, Paolo, Bortoluzzi, Stefania, Zamarchi, Rita, Bisogno, Gianni
• Format: Article
• Language: English
• Subjects: Antibodies; Automation; Biomarkers; Biopsy; Bone marrow; Cancer therapies; CellSearch; cfDNA; Clinical significance; Cloning; CTC; Deoxyribonucleic acid; Desmin; Development and progression; DNA; Ethylenediaminetetraacetic acid; Ewings sarcoma; Flow cytometry; Medical prognosis; Mesenchyme; Metastases; Metastasis; Patients; Pediatrics; Peripheral blood; Rhabdomyosarcoma; RMS; Stem cells; Tumor cells; Tumors; whole‐exome sequencing
• ISSN: 1574-7891; 1878-0261
• DOI: 10.1002/1878-0261.13197

Liquid biopsy analysis represents a powerful and noninvasive tool to uncover biomarkers for disseminated disease assessment and longitudinal monitoring of patients. Herein, we explored the value of circulating and disseminated tumor cells (CTC and DTC, respectively) and cell‐free DNA (cfDNA) in pediatric rhabdomyosarcoma (RMS). Peripheral blood and bone marrow samples were analyzed to detect and enumerate CTC and DTC, respectively. We used the epithelial cellular adhesion molecule (EpCAM)‐based CellSearch platform coupled with an automatic device to collect both EpCAM‐positive and EpCAM‐low/negative CTCs. The standard assay was implemented, including the mesenchymal marker desmin. For selected cases, we molecularly profiled primary tumors and liquid biopsy biomarkers using whole‐exome sequencing and droplet digital PCR, respectively. RMS patients with metastatic disease had a significantly higher number of CTCs compared to those with localized disease, whereas DTCs were detected independently of disease presentation. The use of the desmin marker remarkably increased the identification of CTCs and DTCs in RMS samples. Of note, CTC clusters were detected in RMS patients with disseminated disease. Further, cfDNA and CTC molecular features closely reflected the molecular makeup of primary tumors and informed of disease course. This study shows that circulating tumor cells (CTCs) are detectable in blood and bone marrow of patients with rhabdomyosarcoma and that most CTCs express the mesenchymal marker desmin. We detected CTC clusters and high levels of cell‐free DNA in metastatic rhabdomyosarcoma patients. The concurrent evaluation of cell‐free DNA and CTCs, as well as their molecular characterization, was informative of tumor evolution and therapeutic response.