The ability to detect disseminated disease early, as soon as a cancer is diagnosed or after the surgical removal of a seemingly localised solid tumour, would greatly benefit patients. Those requiring adjuvant systemic therapy could quickly be identified and treated, while those whose tumours have not spread could be spared the ordeal of unnecessary chemotherapy.
Disseminated disease can be detected in the sentinel lymph node by searching for micro metastases in the blood via the circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) or in the bone marrow with disseminated tumour cells (DTCs).
Will blood tests replace invasive biopsies?
1) Circulating tumour cells and disseminated tumour cells
Project coordinated by Prof Jean-Yves Pierga (IC) and Dr François-Clement Bidard (IC)
This program covers all aspects of circulating tumour cells from the most fundamental to the most applied aspects. Its objectives include potentially all clinical and basic applications described in the diagram below.
Several clinical trials, promoted by Institut Curie, led by Prof Jean-Yves Pierga and aimed at assessing the clinical utility of CTCs in metastatic breast cancer situation are underway :
• Circe 01, Evaluation of the interest circulating tumour cells follow up in the case of metastatic breast cancer from the third line chemotherapy
• STIC CTC, Medical and economic evaluation of the use of circulating tumour cells to guide treatment decision for metastatic hormone-dependent breast cancer - STIC CTC METABREAST
• Circe T-DM1, Validity of HER2-amplified circulating tumour cells as a decision tool metastatic HER2-negative breast cancer considered for trastuzumab-emtansine (TDM1) treatment
2) Circulating tumour DNA
Project coordinated by Dr Marc-Henri Stern (Inserm / IC) and Dr Olivier Lantz (IC)
This project aims to develop new technologies to detect ctDNA (rearranged and mutated sequences) and implement observational studies in uveal melanoma, triple negative breast cancer, ovarian cancer and neuroblastoma.
A clinical trial, promoted by the Institut Curie and led by Prof Jean-Yves Pierga is in progress : CirCA01, circulating tumour DNA detection and monitoring of women carrying a BRCA1 mutation.
New therapeutic strategy
First in man demonstration of the effectiveness of anti-HER2 therapies for breast cancer with activating mutations of HER3 (Bidard et al, Ann Oncol, 2015).
Advanced diagnostic and prognostic
- Demonstration of the clinical validity of the use of CTC for metastatic breast cancer (Bidard et al, Lancet Oncol 2014).
- Comparison of the clinical validity of ctDNA and CTC as prognostic biomarkers for uveal melanoma (Bidard et al, Int J Cancer 2013) and triple negative breast cancer (Madic et al, Cancer Int J Cancer, 2014).
- Using ANDct as non-invasive alternatives to biopsy for genotyping of tumors and Precision Medicine as part of a prospective trial on all tumor types (Lebofksy et al, Mol Oncol. 2015).
- Clinical utility of circulating tumor cells in metastatic breast cancer. (Bidard et al, J Clin Oncol, 2015)
- Prognostic value of circulating tumor cells in inflammatory breast cancer. (Bidard et al, J Natl Cancer Inst, 2015)
Basic research and methodological approaches