Novel approaches in cancer management with circulating tumor cell clusters

Tumor metastasis is responsible for the vast majority of cancer-associated morbidities and mortalities. Recent studies have disclosed the higher metastatic potential of circulating tumor cell (CTC) clusters than single CTCs. Despite long-term study on metastasis, the characterizations of its most potent cellular drivers, i.e., CTC clusters have only recently been investigated. The analysis of CTC clusters offers new intuitions into the mechanism of tumor metastasis and can lead to the development of cancer diagnosis and prognosis, drug screening, detection of gene mutations, and anti-metastatic therapeutics. In recent years, considerable attention has been dedicated to the development of efficient methods to separate CTC clusters from the patients’ blood, mainly through micro technologies based on biological and physical principles. In this review, we summarize recent developments in CTC clusters with a particular emphasis on passive separation methods that specifically have been developed for CTC clusters or have the potential for CTC cluster separation. Methods such as liquid biopsy are of paramount importance for commercialized healthcare settings. Furthermore, the role of CTC clusters in metastasis, their physical and biological characteristics, clinical applications and current challenges of this biomarker are thoroughly discussed. The current review can shed light on the development of more efficient CTC cluster separation method that will enhance the pivotal understanding of the metastatic process and may be practical in contriving new strategies to control and suppress cancer and metastasis.