Abstract 670: CXCR4 expression in tumor associated circulating cells of patients with pancreatic cancer is prognostic for progression and overall survival
Authors: Gardner Kirby P. , Tsai Susan , Aldakkak Mohammed , Gironda Stephen , Tang Cha-Mei , Adams Daniel L. 
Published: July 2021

Abstract
Background:
CXCR4 is a chemotaxis receptor implicated in the progression of Pancreatic Cancer (PC) via the activation and invasion of tumor cells. To better elucidate its role in the PC metastasis, we examined the role of CXCR4 expression on a variety of tumor associated circulating cells (TACs) [i.e. circulating tumor cells (CTCs), epithelial to mesenchymal cells (EMTs), and cancer associated macrophage-like cells (CAMLs)] as it relates to patient outcomes. A PC cell line PANC-1 was used to model the activation and expression pathway of CXCR4 in cells. Then blood samples were procured from 30 PC patients prior to the start of therapeutic intent to evaluate CXCR4 expression in TACs. CAMLs, EMTs, and CTCs were found in 93%, 63%, and 30% of PC patients respectively, with high CXCR4 expression found to significantly relate with higher TAC populations in circulation. Further, in a 2-year univariate analysis it was found that high expression of CXCR4 in CAMLs or EMTs was significantly related to both progression free survival (PFS) and overall survival (OS). These data suggest that CXCR4 expression in circulating cells in PC is strongly related to the progression and metastatic spread of the disease.
Methods:
PANC-1 cells were used to examine the expression and upregulation of CXCR4 by staining with an anti-CXCR4 antibody after stimulation with Isoproterenol. A prospective pilot study was initiated using anonymized peripheral blood samples from (n=30) PC patients, obtained in accordance with local IRB regulations with informed consent. TACs were isolated from the blood using a low-flow CellSieve Microfiltration system and stained for cytokeratin, CXCR4, and CD45. Wilcoxon ranked sum test and univariate analysis were used to analyze the association of CXCR4 expression on all TACs and to evaluate 24-month PFS/OS.
Results:
Within the PANC-1 cell line, we observed a median expression of CXCR4 intensity of roughly 210 after activation and upregulation with Isoproterenol. Within TACs in the circulation, higher numbers of CAMLs (p=0.017), EMTs (p=0.001), and CTCs (p&lt;0.001) were all significantly related to cells with ≥210 CXCR4 expression. Further, higher expression of CXCR4 on CAMLs correlated with worse PFS (HR=4.0, 95%CI 1.5-10.5, p=0.012) and worse OS (HR=4.8, 95%CI 1.7-13.1, p=0.006), with higher CXCR4 expression in EMTs also correlated with worse PFS (HR=4.6, 95%CI 1.2-15.4, p=0.033) and worse OS (HR=5.4, 95%CI 1.5-19.2, p=0.021). Expression of CXCR4 in CTCs was not significant for PFS or OS.
Conclusion:
Expression of chemotaxis related receptor CXCR4 appears to have a strong relationship to higher numbers of TACs in circulation. This higher CXCR4 expression in CAMLs and EMTs also appears to correlate with rapid progression and death, indicating a relationship CXCR4 in the spread of PC and its potential use as a target for therapy.
Citation Format: Kirby P. Gardner, Susan Tsai, Mohammed Aldakkak, Stephen Gironda, Cha-Mei Tang, Daniel L. Adams. CXCR4 expression in tumor associated circulating cells of patients with pancreatic cancer is prognostic for progression and overall survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 670.