Tumor-derived cell-free DNA and circulating tumor cells: partners or rivals in metastasis formation?

Abstract

The origin of metastases is a topic that has sparked controversy. Despite recent advancements, metastatic disease continues to pose challenges. The first admitted model of how metastases develop revolves around cells breaking away from the primary tumor, known as circulating tumor cells (CTCs). These cells survive while circulating through the bloodstream and subsequently establish themselves in secondary organs, a process often referred to as the “metastatic cascade”. This intricate and dynamic process involves various steps, but all the mechanisms behind metastatic dissemination are not yet comprehensively elucidated. The “seed and soil” theory has shed light on the phenomenon of metastatic organotropism and the existence of pre-metastatic niches. It is now established that these niches can be primed by factors secreted by the primary tumor before the arrival of CTCs. In particular, exosomes have been identified as important contributors to this priming. Another concept then emerged, i.e. the “genometastasis” theory, which challenged all other postulates. It emphasizes the intriguing but promising role of cell-free DNA (cfDNA) in metastasis formation through oncogenic formation of recipient cells. However, it cannot be ruled out that all these theories are intertwined. This review outlines the primary theories regarding the metastases formation that involve CTCs, and depicts cfDNA, a potential second player in the metastasis formation. We discuss the potential interrelationships between CTCs and cfDNA, and propose both in vitro and in vivo experimental strategies to explore all plausible theories.

Advances in circulating tumor cells for early detection, prognosis and metastasis reduction in lung cancer

“…Upon survival, CTCs preferentially extravasate from the circulation into the pre-metastatic niche (PMN), experience mesenchymal to epithelial transition(MET) and move to new metastatic sites as disseminated tumor cells (DTCs) (52,56). PMN is formed before the primary tumor reaches the DTC, and the original tumor modifies the microenvironment by releasing growth factors, exosomes, and extracellular matrix remodeling in order to facilitate tumor metastasis.…”