Results show a statistically significant median 1.5-fold increase in CTCs captured with the FETCH system compared with CellSearch, accompanied by a median twofold reduction in non-specifically captured leukocytes. This increase in CTC capture can aid the comprehensive analysis of CTCs in a larger number of patients, further supporting clinical implementation of CTC-based diagnostics.
Concurrent ESR1 mutations and methylation were identified in six cases, suggesting combined genetic and epigenetic mechanisms of endocrine resistance. Overall, CTC-derived genomic DNA showed higher sensitivity for detecting ESR1 mutations than plasma ctDNA, supporting the potential value of CTC analysis for characterizing endocrine resistance in advanced BC.
These findings indicate that PD-L1+CTCs reflect tumor-driven immune suppression and may facilitate metastatic spread. Therefore, PD-L1+CTCs should be considered as promising prognostic biomarkers and may provide a rationale for early immunotherapy.
Integration with other circulating biomarkers, such as circulating tumour DNA and exosomes, promise enhanced prognostic and diagnostic accuracy. Standardization of protocols and validation in clinical samples will be critical for translating these technologies into routine oncology practice.