Liquid Biopsy for Monitoring EC Patients: Towards Personalized Treatment

Abstract

Endometrial cancer (EC) is the most frequent gynecological cancer in developed countries and its incidence shows an increasing trend. Fortunately, the prognosis of the disease is good when the tumour is diagnosed in an early phase, but some patients recur after surgery and develop distant metastasis. The therapy options for EC for advanced disease are more limited than for other tumours. Therefore, the application of non-invasive strategies to anticipate the recurrence of localized tumours and guide the treatment in advanced stages represents a clear requirement to improve the survival and quality of life of patients with EC. To achieve this desired precision oncology, it is necessary to invest in the identification and validation of circulating markers that allow a more effective stratification and monitoring of patients. We here review the main advances made for the evaluation of circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), circulating extracellular vesicles (cEVs), and other non-invasive biomarkers as a monitoring tool in the context of localized and advanced endometrial tumours, with the aim of providing a global perspective of the achievements and the key areas in which the use of these markers can be developed into a real clinical tool.

Endometrial cancer diagnostic and prognostic algorithms based on proteomics, metabolomics, and clinical data: a systematic review

“…As thoroughly discussed, body fluids and liquid biopsies represent the most suitable material for diagnostic and prognostic biomarkers ( 162 , 163 ), as they capture the disease heterogeneity better than a biopsy and they are non- or minimally invasive, thus create less anxiety in patients. In the context of the most appropriate body material, plasma preparation is less prone to technical (pre-analytical) biases than serum.…”

RNA 5-Methylcytosine regulators are associated with cell adhesion and predict prognosis of endometrial cancer

“…Furthermore, they have significant potential in informing the indications for FST. However, its potential is currently limited due to the absence of prognostic markers that can be measured during disease progression ( 41 ). Therefore, there is a need to enhance our comprehension of epigenetic mechanisms and the epigenome for their clinical application.…”

Advances in novel strategies for isolation, characterization, and analysis of CTCs and ctDNA

“…1 Liquid biopsy has significant advantages over traditional tissue biopsies in being minimally invasive and allowing for dynamic analysis and real-time monitoring of tumor progression and treatment response. 2 In addition, liquid biopsies have shown a superior representation of intratumoral heterogeneity when compared to tissue biopsies and are appropriate for longitudinal tracking of cancer development as well as identifying tumor cells that confer resistance. 1,3 Dynamic investigations of molecular or cellular biomarkers are made more accessible by liquid biopsy.…”

“…Components like CTCs and ctDNA are shed from the primary tumor site and enter the bloodstream, thereby contributing to the spread of malignancy. 2,3,8 However, their low concentration (1–1000 CTCs per mL) and high degradability make them challenging to detect and analyze. 9 Furthermore, the morphological resemblance of CTCs to some WBCs, phenotypic heterogeneity, and epithelial-to-mesenchymal transition (EMT) represents a significant challenge for any isolation and characterization approach in cancer research.…”