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Publications

Journal Article Review Epublish

PubMed: 40340939 DOI: 10.1186/s13046-025-03371-1

Liquid biopsy in gynecological cancers: a translational framework from molecular insights to precision oncology and clinical practice.

J Exp Clin Cancer Res 44(1):140

Authors: Canio Martinelli, Alfredo Ercoli, Giuseppe Vizzielli, Sharon Raffaella Burk, Maria Cuomo, Vrunda Satasiya, Housem Kacem, Simone Braccia, Giulio Mazzarotti, Irene Miriello, Manuela Nana Tchamou, Stefano Restaino, Martina Arcieri, Alice Poli, Veronica Tius, Silvana Parisi, Stefano Pergolizzi, Giuseppe Iatì, Chiara Conti Nibali, Cristina Pizzimenti, Ludovica Pepe, Antonio Ieni, Salvatore Cortellino, Antonio Giordano

Affiliations

  • Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, 1900 N 12 St, Philadelphia, PA, 19122, USA.
  • Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Obstetrics and Gynecology, University of Messina, Via Consolare Valeria 1, Messina, 98124, Italy.
  • Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
  • Department of Medical Biotechnology, University of Siena, Via Aldo Moro 2, Siena, 53100, Italy.
  • Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
  • Department of Pharmacy, School of Medicine, University of Naples Federico II, Via Domenico Montesano 49, Naples, 80131, Italy.
  • Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, 98125, Italy.
  • Section of Pathological Anatomy, Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", G. Martino Hospital, Messina, 98125, Italy.
  • Clinical and Translational Oncology, Scuola Superiore Meridionale (SSM), Naples, Italy.
  • Laboratory of Molecular Oncology, Research Hospital, Campobasso, 86100, Italy.
  • SHRO Italia Foundation ETS, Candiolo, Turin, Italy.
  • Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, 1900 N 12 St, Philadelphia, PA, 19122, USA.
  • Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.

Abstract

Liquid biopsy offers a noninvasive method to identify and monitor tumor-derived biomarkers, including circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, microRNAs, and tumor-educated platelets, that provide real-time insights into the biological behavior of gynecological cancers. The detection of these markers has the potential to revolutionize cancer management by enabling earlier detection, providing novel data to personalize treatments, and predicting disease recurrence before clinical imaging and predicting disease recurrence before clinical imaging can confirm progression, thereby also guiding complex clinical decision-making. However, because this new "omics" layer introduces additional complexity, it must be fully understood, from its biological rationale to technical development and clinical integration, to prevent confusion or misapplication. That is why, focusing on 14 critical fields of inquiry, our goal is to map the current state of liquid biopsy from bench to bedside while highlighting practical considerations for clinical integration. Each topic integrates recent advances in assay sensitivity, biomarker variability, and data interpretation, underscoring how standardized protocols and robust analytical methods are pivotal for reliable results. We then translate these findings into disease-specific insights, examining how liquid biopsy could refine early detection, minimal residual disease assessment, and therapy guidance in endometrial, cervical, and ovarian cancers. Although several FDA-approved assays and promising commercial tests illustrate the field's rapid evolution, many translational hurdles remain, including the need for harmonized protocols, larger prospective clinical trials, and cost-effectiveness analyses. Crucially, our synthesis clarifies the pivotal role of interdisciplinary collaboration. Oncologists, laboratory scientists, and industry partners must align on standardized procedures and clinically relevant endpoints. Without such coordination, promising biomarkers may remain confined to research settings, limiting their practical benefit. Taken together, our review offers a translational view designed to contextualize liquid biopsy in gynecological oncology.

MeSH

Neoplasms, Biopsy, Biomarkers, Therapeutics, Liquid Biopsy

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