Regional chemotherapy directed by individual chemosensitivity testing in vitro: a prospective decision-aiding trial.
A prospective decision-aiding trial was performed to select drugs for regional chemotherapy of various liver tumors (n = 36) by individual drug testing. The drugs were chosen for hepatic artery infusion according to the individual chemosensitivity of tumor biopsies in the human tumor colony-forming assay (HTCA). In vitro HTCA sensitivity correlated with complete response (CR) + partial response (PR) + no change (NC) 93% of the time and with CR + PR 55% of the time. The test sensitivity was 90%, and the specificity was 67% for CR + PR + NC versus progressive disease (PD), whereas the sensitivity and specificity were 89% and 28%, respectively, for CR + PR versus NC + PD. The overall predictive accuracy of the test was 86% for CR + PR + NC versus PD and 58% for CR + PR versus NC + PD. Overall, 83% of this heterogenous patient group with various tumors achieved CR + PR + NC and a 50% clinical response (CR + PR). In vitro-sensitive patients showed a significantly lower intrahepatic progression rate (7% PD) than in vitro-resistant patients (57%; P < 0.05). These results indicate that the HTCA could identify active drugs for individualized hepatic artery infusion, and patients may profit from the use of in vitro-sensitive drugs.
Link
K H
KH
Department of General Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany.
Kornmann
M
M
Leder
G H
GH
Butzer
U
U
Pillasch
J
J
Staib
L
L
Gansauge
F
F
Beger
H G
HG
D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000627:therapeutic use; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D008942:Mitoxantrone / Q000627:therapeutic use; D014411:Neoplastic Stem Cells / Q000187:drug effects*; D011446:Prospective Studies; D014410:Tumor Stem Cell Assay
D000931:Antidotes; D000970:Antineoplastic Agents; D016685:Mitomycin; D004317:Doxorubicin; D008942:Mitoxantrone; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil