Use Of In Vitro Drug Response Assay Shows Promise In Lung Cancer Treatment
Chemotherapy is the best broad defense against Cancer recurrence after surgical resection. However, it is difficult to predict which patients will benefit from which regimen of anticancer drugs, if at all. Building on existing knowledge, a study published in the September edition of the Journal of Thoracic Oncology (JTO), analyzed the usefulness of adjuvant chemotherapy for non-small cell Lung Cancer (NSCLC) based on the histoculture drug response assay (HDRA). After seven years of study, researchers concluded that the use of adjuvant (post-operative) chemotherapy based on results of the in vitro HDRA improved the survival and prognosis of patients with NSCLC who had undergone surgery and whose results of the HDRA assay showed chemosensitivity to the specific drugs used for treatment.
The patients’ chemosensitivity to cisplatin, carboplatin, paclitaxel, docetaxel, gemcitabine and irinotecan were examined by the HDRA assay. The patients in the study were then split into two groups: (1) those whose tumors were sensitive to at least two of the HDRA drugs and received two HDRA positive drugs per chemotherapy session (31 patients) and (2) those whose tumors were sensitive to one or none of the HDRA drugs and were treated with a combination of one HDRA positive drug and one HDRA negative or two HDRA negative drugs per chemotherapy session (34 patients).
The overall five-year survival rate for the prediction sensitive group given two HDRA positive drugs was 82.4 percent. In contrast, the five-year survival rate for the patients whose tumors indicated a low sensitivity or no sensitivity to the HDRA drugs and received one HDRA positive drug and one HDRA negative or two HDRA negative drugs was 40.1 percent. Additionally, the rate of relapse was lower for the patients in the prediction sensitive group. Relapse occurred in 29 percent of patients who were given two HDRA positive drugs per chemotherapy session while it occurred in 55.8 percent of patients who underwent the other treatment.
“Our research concluded that the HDRA assay seems to be useful for the selection of anticancer drugs in chemotherapy,” explained lead investigator, Masayuki Tanahashi, MD. However, Dr. Tanahashi and his colleagues recommend further research into this treatment option.
Source:
Colleen Butz
International Association for the Study of Lung Cancer
Source: http://www.medicalnewstoday.com/articles/199782.php
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about 1 year ago
The HDRA (Histoculture Drug Response) Assay, which was used for this study is one of a number of “cell-death” assays.
Cell death assays are broadly applicable to a wide range of human neoplasms, ranging from low response rate tumors (like pancreatic cancer and Cholangiocarcinoma) to high response rate tumors (like acute lymphoblastic leukemia, breast cancer and ovarian cancer).
In cases where more than one acceptable regimen exists, the physician can select the regimen containing the most favorable drugs and avoid the regimen containing the most unfavorable drugs.
The main feature of the HDRA assay is three dimiensional (3D) culture which determines both drug sensitivity and resistance. Real life 3D analysis makes the HDRA assay indicative of what will happen in the body.
What is the precedent for using these cell culture assay tests?
It has been found that newer methods of “cell-death” assays have an overall predictive accuracy of 98.2% concerning treatment response, which compares favorably with older, previously published data ranging from 75% to 92%. (Staib,P.et al. Br J Haematol 128 (6):783-781, March 2005)
We have tests such as estrogen receptor, progesterone receptor, Her2/neu, BCR-ABL, C-KIT, CD-20, etc., and panels of immunohistochemical stains for subclassifying tumors. All of these tests are used to select chemotherapy in precisely the same manner as cell culture assay tests are used.
We also have the use of additional medical tests, such as serial CT, MRI, and PET scans, performed for the purpose of monitoring the size of the tumor to determine if it is shrinking or growing with chemotherapy. The purpose of this testing is to determine if chemotherapy with specific drugs should be continued or changed to different drugs. These radiographic tests are also used as an aid in making clinical decisions about the choice of chemotherapy.
So yes, there is precedent for using cell culture assays.