Circulating Tumor Cells


Having developed and validated the Ikoniscope platform for pre-natal and cancer diagnosis, the company is engaged, moving forward, in expanding the applications of the platform. One area of particular interest is the analysis of circulating tumor material as a ‘liquid biopsy’ for early diagnosis, detection of recurrence, risk assessment, to assess prognosis, to monitor response to treatment, to aid diagnosis and to guide treatment decisions. It should be noted that the existence and potential clinical utility of tumor material in the circulating blood has been recognized for many years but clinical utilization has been slow to progress. Circulating tumor material is available for ‘liquid biopsy’ as either Circulating Tumor Cells (CTC) or Circulating tumor DNA (ctDNA). The analysis of CTC and ctDNA are complementary approaches, with each approach contributing valuable information; CTC for characterization of individual tumor cells and ctDNA for global tumor genotype information. The challenges of the cell based (CTC) approach are largely related to the rarity of the CTC (1 per ml blood) and the variety of CTC cell types, limiting the value marker specific enrichment approaches. Many approaches have been taken to CTC enrichment/detection, including flow sorting, magnetic cell sorting, microfluidics and filtration, with no one approach clearly superior to others. 

Being developed specifically for rare cell detection and analysis, the Ikonisys platform, is particularly well suited to the detection and analysis of CTCs. Initial validation of the potential of the Ikoniscope for CTC detection and analysis was provided by a collaboration with Sir Walter Bodmer's group at the University of Oxford, UK. (1) that demonstrated an Ikoniscope-based simple and rapid procedure for the clear-cut identification of CTCs.

The approach was shown to have considerable promise for screening, early detection of recurrence and evaluation of treatment response for a wide variety of carcinomas. Building on this, development of the Ikoniscope platform for CTC analysis has concentrated on developing a flexible approach with no prerequisite sample preparation requirement. Unlike the vast majority of approaches being proposed for CTC testing, the Ikoniscope has the potential to be applied to the analysis of CTC samples prepared by any enrichment method. Indeed, the ability to analyse up to 2 million cells per slide allows samples to be analysed with no enrichment. This approach was presented at the 2017 EPMA World Congress (2,3). In summary, Ikonisys CTC approach allows any desired enrichment approach to be used prior to cell deposition and has the sensitivity to analyse samples with no enrichment. Samples can be analysed for positive and/or negative selection of any target CTC for any combination of up to 5 antibody and/or FISH markers and detected CTCs can be classified based on quantitation of those markers.

1) Detection of circulating tumour cells in peripheral blood with an automated scanning fluorescence microscope. Ntouroupi et al. BJC 2008.
2) 'Predictive, Preventive & Personalized Medicine'. (EPMA World Congress Malta 2017).
3) Detection and Analysis of Circulating Tumour Cells in Small Cell Lung Cancer Utilizing a Flexible Rare Cell Scanning Platform. Kilpatrick et al. EPMA J 2017.