Circulating tumour cell clearance as the phase 2 gate for anti-metastatic drugs
Cancer cells travelling in the blood can be counted. If a drug clears them, that is an early sign it may stop spread, and it reads out in weeks rather than years.
CTC count is an established prognostic marker in metastatic breast, prostate and colorectal cancer, and CTC conversion from unfavourable to favourable has been used as a response measure in prostate cancer. Anti-metastatic mechanisms such as platelet cloaking, trap-mediated capture and cluster formation should show up as CTC and CTC-cluster clearance long before imaging changes. A standardised cluster readout would give small, cheap, fast phase 2 decisions.
- Metastasis is understood least and studied last · Metastasis causes about nine in ten cancer deaths but gets a small fraction of research money and almost no trials of its own.
- Biomarkers are not validated or standardised · Tests that decide who gets a drug are often not validated prospectively and are measured differently in every lab.
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