Detection of circulating tumor cells and their correlation with clinical evolution in epidermoid carcinoma of head and neck

Abstract

Head and neck cancer represents 6% of new cancer cases diagnosed annually, accounting for 650,000 new cases around the world. Its management is multidisciplinary and despite all efforts, about 50% of patients show disease recurrence.The spread of cancer requires the presence of circulating tumor cells (CTCs), which are rare cells surrounded by billions of hematopoietic cells.There are some published studies showing a correlation between expression of genes conferring resistance / sensitivity and response to drug therapy, but very few have shown their expression in CTCs and correlates finding this with the expression in the tumor.This will be a prospective study, performed by collecting blood from patients with head and neck squamous cell carcinoma (n = 60) in three scenarios: 1) patients undergoing curative surgical resection and adjuvant treatment (radiotherapy associated or not to chemotherapy), with the aim of reducing the risk of disease recurrence; 2) patients with unresectable tumors or candidates for organ-preserving strategy, that will undergo nonsurgical treatment based on combination of radiation, chemotherapy and / or targeted therapies (concomitant chemoradiotherapy, biorradioterapy concomitant induction chemotherapy followed by chemo or biorradiotherapy); 3) patients with recurrent or unresectable metastatic disease that are candidates for systemic palliative treatment in order to gain overall survival and improve quality of life. For CTCs analysis we will use blood of healthy individuals as negative control and as positive control, this same blood spiked with colon tumor cells maintained in culture. The isolation and detection of CTCs will be achieved by MACS / Miltenyi ® and ISET (Isolation by Size of Epithelial Tumor Cells) systems. The latter one will also allow analysis of protein expression of resistance genes (ERCC1, EGFR and ²III-tubulin). Using Tissue Microarray (TMA), analysis of the expression of such proteins will also be performed on samples of primary tumors of the head and neck. The data obtained will be correlated with imaging, treatment response and survival. We hope identify a blood marker for monitoring response to therapy that also indicates resistance / sensitivity to drugs commonly used in the treatment of squamous cell carcinoma of the head and neck. (AU)