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In metastatic cancer, especially during treatment, the tumour continuously changes, leading to resistance. When this happens, we can no longer use biopsies to guide treatment and follow-up treatments are therefore poorly guided and often ineffective. To improve treatment effectiveness, there is a need to assess patient specific expression of both known and novel protein-level treatment targets, which allows the prescription of precision medicine.

Metastatic cancer spreads through the blood. This means that the ongoing spread happens through tumour cells present in the blood, the so-called Circulating Tumour Cells (CTCs). These CTCs offer an insight into the most relevant part of the cancer, as they reflect the most aggressive part of the tumour. While technology exists to detect these CTCs from blood tubes, these provide insufficient material for analysis, as in most blood tubes from metastatic patients only one, or even zero tumour cells are found. This is not because these patients do not have any tumour cells in circulation, they are just not found in the small volume of blood screened.

FETCH solves this limitation by detecting CTCs from the entire blood volume, using leukapheresis. In this standard hospital procedure, specific blood components are extracted from the blood, among which also tumour cells. As the other blood components such as red blood cells and plasma are returned to the patient, this procedure can be repeated regularly to follow the patients progression. However, due to cell clumping, current methods can only process ~2 to 5% of such a leukapheresis product, preventing its use.

FETCH has developed a novel method that allows detection of CTCs from the full sample, without clumping. This results in a 200-fold increase in tumour cell yield, while decreasing the amount of reagents needed. Published clinical results have already proved the FETCH principle to work using clinical samples from prostate cancer patients. The lab-scale setup is currently being further developed into a proof-of-concept device, that can be used by academic research laboratories.

With this, FETCH will enable reliable tumour cell detection in all metastatic cancer patients at multiple time points. This allows (pharmaceutical-) researchers to study response and resistance mechanisms as well as tumour heterogeneity evolution. For clinical applications, it provides a way to determine the patients most relevant tumour characteristics. This will initially allow selection of the most effective targeted therapy, but eventually also adaptation of the therapy, to specific characteristics of the patients tumour. In this way, by providing easy evaluation of the most relevant part of the tumour, FETCH opens up the potential of truly personalized therapy.