Pentsova Elena
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Front Oncol. 2024 Sep 30;14:1409383. doi: 10.3389/fonc.2024.1409383. eCollection 2024.
A common feature of advanced solid tumors is their ability to metastasize and colonize distant organs, including the Central Nervous System (CNS), which encompasses brain and leptomeningeal metastases (LM). While cerebrospinal fluid cytopathological analysis remains a gold standard diagnostic tool, it only provides limited insights into the biology of tumor cells; thus, it is urgent to develop minimally invasive biomarkers that enable a comprehensive quantitative and molecular characterization of disseminated cells, therapy response assessment, and disease monitoring. Liquid biopsy methods have been swiftly developed for some readily accessible bodily fluids such as plasma and urine; circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) from these sources have been rapidly implemented into clinical trial design, disease monitoring, and treatment assignment across different tumor types. However, the filter imposed by the brain blood barrier (BBB) hampers the release of tumor-derived cells and molecules from CNS metastases. Crucially, cerebrospinal fluid (CSF) liquid biopsy methods offer a unique and unparallel source to develop liquid biopsy methodologies in patients with CNS-disseminated disease, including the characterization of CTCs and ctDNA arising specifically from brain and leptomeningeal metastasis. These technologies have enabled a deeper understanding of tumor cell and molecular dynamics, including the reconstruction of clonal evolution in the brain microenvironment through longitudinal sapling. Here, we discuss the current challenges and opportunities that CSF liquid biopsy methods face for the implementation of these approaches into clinical settings.
晚期实体瘤的一个共同特征是它们具有转移并在远处器官(包括中枢神经系统(CNS))定植的能力,中枢神经系统转移包括脑转移和软脑膜转移(LM)。虽然脑脊液细胞病理学分析仍然是金标准诊断工具,但它对肿瘤细胞生物学的洞察有限;因此,迫切需要开发微创生物标志物,以实现对播散细胞的全面定量和分子特征分析、治疗反应评估及疾病监测。针对血浆和尿液等一些易于获取的体液,液体活检方法已迅速发展;来自这些来源的循环肿瘤细胞(CTC)和循环肿瘤DNA(ctDNA)已迅速应用于不同肿瘤类型的临床试验设计、疾病监测和治疗分配中。然而,血脑屏障(BBB)形成的屏障阻碍了中枢神经系统转移瘤中肿瘤衍生细胞和分子的释放。至关重要的是,脑脊液(CSF)液体活检方法为患有中枢神经系统播散性疾病的患者开发液体活检方法提供了独特且无可比拟的来源,包括对源自脑和软脑膜转移的CTC和ctDNA的特征分析。这些技术使人们能够更深入地了解肿瘤细胞和分子动态,包括通过纵向采样重建脑微环境中的克隆进化。在此,我们讨论脑脊液液体活检方法在将这些方法应用于临床时面临的当前挑战和机遇。