Microfluidics, CTC Capture, Analysis and Expansion

Cancer remains among the most common causes of morbidity and mortality worldwide. Although screening methods and better systemic treatment have led to a decrease in cancer-related mortality, patients with metastatic disease mostly remain incurable (Lambert et al., 168:670–691, 2017; Sethi and Kang, 11:735–748, 2011; Lin et al., Signal Transd Target Ther 6:404, 2021). Development of novel therapies, which in many cases are highly targeted, provides hope for better cancer management (Labrie et al., Nat Rev Cancer, 2022). However, the fact still remains that even these novel therapies work best when cancer is detected in the early stages (Lønning, Trends Cancer 7:181–185, 2021). We review liquid biopsy-based early detection technologies that are poised to providing the clinicians the ability to better manage cancer patients and decrease mortality rates (Etzioni, Nat Rev Cancer 3:243–252, 2003). Thomas Ashworth discovered in 1869 that distant metastatic spread occurs through the circulatory system (Ashworth, 14:146, 1869). This discovery was made through a microscopic observation of cells with similar morphology to the primary tumor found in blood of a man with metastatic disease (Ashworth, 14:146, 1869; Wit et al., Scientifica 2014:819362, 2014). This discovery has now lead to a fast growing field which has been coined the term liquid biopsy. Clinical applications of liquid biopsy hold the promise for early cancer detection, real-time monitoring of treatment efficacy, improved cancer staging, early detection of relapse, possible future therapeutic targets as well as a better understanding of resistance mechanism, and the possibility of personalized targeted therapy (Alix-Panabières and Pantel, Cancer Disc 11:858–873, 2021.