Background

Circulating tumor cells (CTCs) are a predictive biomarker for accounting for disease progression and for minimal residual disease (MRD). The effect of conventional anticancer therapy on CTC count is well documented; however, there is a paucity of data related to the effect of CAM-based modalities on CTC count in cancer patients. This study provides a preliminary observation about the effect of Ayurveda therapy on CTC count.

Methods

The retrospective study involved the stratification of 72 cancer patients undergoing cancer and maintenance treatment in a non-conventional, Ayurveda cancer treatment center in India. For monitoring of prognosis in cancer patients, CTC count was assessed in patients attending the Rasayu Cancer Clinic. Seventeen cancer types were included, namely, breast cancer, cervix and ovarian cancer, bladder, lung, head and neck squamous carcinoma, follicular thyroid, diffuse B-cell lymphoma, Hodgkin’s and non-Hodgkin’s, colorectal, hepatocellular, stomach with abdominal metastasis, metastatic prostate cancer, SCC with lung and skeletal metastasis, etc. A total of 33 (46%) male and 39 (54.1%) female patients of various types and stages were analyzed for the presence of CTCs retrospectively. CTCs were isolated and enumerated from 1.5 ml of the patient’s blood sample using the OncoDiscover Liquid Biopsy Technology platform enriched with an anti-EpCAM antibody immunomagnetic kit, approved by the Drug Controller General of India (DCGI). CTCs were confirmed for cytokeratin 18+ (CK18), DAPI+, and CD45-. Subsequently, CTCs were imaged using a Zeiss Axio Observer 7 fluorescence microscope. In 28 patients (50%), CTCs were accounted for at both pre- and post-treatment over a duration of 3-6 months. Twenty-eight patients were assessed for quality of life measured by the FACT-G questionnaire. The outcome was quantified for clinicopathological parameters: age/gender, cancer types, and CTC distribution.

Results

The mean and median CTC distribution was observed to be 15.34 and 12.5, respectively. Eight percent of patients showed the absence of any CTCs (6 subjects: 1 male and 5 females), while 32 males (96%) and 34 females (87%) showed the presence of CTCs. The correlation coefficient of CTC presence in males and females was significant at 0.4799 (p < 0.05). The Ayurveda Rasayana therapy showed a significant reduction in post-interventional CTC count (-3.94 ± 1.2) (p = 0.02). In addition, this group of patients also showed significant improvement in health-related quality of life as measured by the FACT-G questionnaire (p < 0.05).

Conclusions

CTCs are a validated predictive biomarker for accounting for minimal residual disease, both in pre- and post-cancer treatments. The enumeration of CTCs represents an effective prognostic biomarker in assessing disease progression. A reduction in CTC count was seen to be associated with an improvement in health-related quality of life (QoL), which needs to be investigated further to establish a firm correlation.