Tumor Liquid Biopsy Of CETC – State Of The Art And New Developments

100 years of clinical knowledge, metastases are derived from tumor cells shed into the blood 1998laser scanning microfluorimetry with cell relocation after e.g. secondary staining 2001 firstgeneration tumor cell enrichment, admixture of blood cells and questionable quantitativity,prognostic factor only in metastatic disease 2006 first quantitative determination, distinctionbetween live and dead cells, course of cells dynamics during therapy and over years duringmaintenance therapy, chemosensitivity 2011 different and partly debatable ways of purification,detection of mutations in single tumor cells, tumor stem cell surrogates 2014 first functional tumorstem cell test, single tumor cell analysis, determination of the AR-V7 splice variant and ofimmunologically relevant PD-L1 expression 2016 first fully automated quantitation includingsecondary stainings and chemosensitivity Direct quantitative cell counting yields control inadjuvant therapy, control in neo-adjuvant therapy and control in endocrine treatment(Gynecological / prostate cancers) Additional therapeutically relevant information comes fromHer2/neu FISH via receptor blockade, from selective cell killing by cytotoxic agents (movie) as wellas from detection of mutations enabling precision therapies (BRAF, KRAS, EGFR-Variants), fromImmunological disarmament of the tumor by PD-1 Ligand blockade and from making use of theresidual chemosensitivity of the Spheroids of tumor stem cells. No bigger support can be expectedbecause more specifically personalized means less cash. The only interventional clinical studywas designed not to have success. Despite of evidence of chances for saving money and time andquality of life for the patient there was no cost effectiveness study yet. Therefore attempts to attainofficial acknowledgement as standard tool failed hitherto, - especially in clinically unclearsituations (in Germany so called Nikolaus-sentence), and - in well-defined clinical situationswithout guide-line recommendation. By using the circulating epithelial Tumor cells tumordiagnostics will become less laborious and tumor therapy will become more effective and moreefficient. The live tumor cell is the measure of success and therefore is the gold standard.