Abstract

The analysis of ctDNA (ctDNA) to stratify and monitor cancer patients is the ‘here and now’, liquid biopsy biomarker, testified by the recent upsurge in the number of biotech companies offering this as a service. However, whilst circulating tumour cells (CTCs) are more technically challenging, they offer more versatility not only as patient management tools but also to explore the biology of metastatic cancers, to identify new drug targets and to support drug development. The increasing number of platforms available to study CTCs and their advantages and disadvantages will be reviewed. I will then focus on the application of CTCs as biomarkers in lung cancer, describing their utility in small cell and non small cell lung cancer trials. The challenges of CTC heterogeneity and how this impacts biomarker development will be discussed. I will overview our development of patient CTC derived explant models (CDX) and how these and cultures developed from them can be used to support drug development. Finally, I will describe how our CTC analysis led to the discovery and interrogation of vasculogenic mimicry in small cell lung cancer.