Unravelling the biological and clinical challenges of circulating tumour cells in epithelial ovarian carcinoma
Faye Lewis, James Beirne, Brian E. Henderson, Lucy Norris, Karen A. Cadoo, Tanya Kelly, Cara Martin, Sinéad Hurley, Marika Kanjuga, Lorraine O’Driscoll, Kathy Gately, Ezgi Öner, Volga M Saini, Doug A. Brooks, Stavros Selemidis, Waseem Kamran, Niamh Haughey, Patrick Maguire, Catherine O’Gorman, Feras Abu Saadeh, Mark P. Ward, John O’Leary, Sharon O’Toole
Abstract
Epithelial ovarian carcinoma (EOC) is the eighth most common cancer in women and the leading cause of gynaecological cancer death, predominantly due to the absence of effective screening tools, advanced stage at diagnosis, and high rates of recurrence. Circulating tumour cells (CTCs), a rare subset of tumour cells that disseminate from a tumour and migrate into the circulation, play a pivotal role in the metastatic cascade, and therefore hold promise as biomarkers for disease monitoring and prognostication. Exploring CTCs from liquid biopsies is an appealing approach for research and clinical practice, given it is minimally invasive, facilitates serial sampling and enables the capture of the entire spectrum of cancer cells circulating in the blood. The prognostic utility of CTC enumeration has been FDA-approved for clinical use in metastatic breast, prostate, and colorectal cancers. However, the unique biology of EOC, discussed herein, compounds the detection and characterisation complexities already inherent in CTC research, consequently hindering progress towards clinical applications. The aim of this review is to provide an overview of both the biological and clinical challenges encountered in harnessing the power of CTCs in EOC. • CTCs hold promise as biomarkers for disease monitoring and prognostication in EOC. • Biological challenges limit CTC utility in EOC, including heterogeneity, limited research models, and unique metastasis. • Advances in CTC technologies could delineate novel mechanisms of EOC metastasis. • Standardising CTC definitions, methodologies, and analysis in EOC is crucial.