title: Selection of chemotherapy by ex vivo assessment of tumor sensitivity to cytotoxic drugs: results of a clinical trial.
abstract: The feasibility of tumor sampling followed by ex vivo assessment of drug sensitivity, using the short-term fluorometric microculture cytotoxicty assay (FMCA), for selection of chemotherapy was investigated prospectively in patients with advanced cancer not amenable to standard treatment. Taxol (175 mg/m2 every 3 wk) was given to patients with tumor samples being low drug resistant (LDR) to Taxol ex vivo, to patients with no LDR drug, and if other drugs were unsuitable. The remaining patients received the most optimal drug(s) based on the FMCA results. Gastrointestinal cancer was dominating among the 61 eligible patients. Tumor sampling was safely performed in 75% by ultrasound-guided core biopsy. Eighty-two percent of the patients had Taxol. Five patients (8%) had a partial remission and 18 (30%) had stable disease. Tumor response was poorly predicted, probably because the Taxol excipient Cremophor EL is cytotoxic exclusively ex vivo. However, patients with tumor cells being LDR to at least one drug ex vivo lived significantly longer than those with no such drug.
authors.affiliation: Departments of Oncology, Radiology, and Clinical Immunology, University Hospital, SE-751 85 Uppsala, Sweden.
authors.forename: Ake
authors.initials: A
authors.lastname: Berglund
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Jonas
authors.initials: J
authors.lastname: Bergh
authors.forename: Ola
authors.initials: O
authors.lastname: Brodin
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Fjällskog
authors.forename: Hans
authors.initials: H
authors.lastname: Hagberg
authors.forename: Anne
authors.initials: A
authors.lastname: von Heideman
authors.forename: Rolf
authors.initials: R
authors.lastname: Larsson
authors.forename: Bengt
authors.initials: B
authors.lastname: Tholander
authors.forename: Manuel
authors.initials: M
authors.lastname: de la Torre
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aström
authors.forename: Kjell
authors.initials: K
authors.lastname: Oberg
authors.forename: Gunnar
authors.initials: G
authors.lastname: Parö
authors.forename: Peter
authors.initials: P
authors.lastname: Nygren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002478:Cells, Cultured; D019008:Drug Resistance, Neoplasm; D004354:Drug Screening Assays, Antitumor / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D017239:Paclitaxel / Q000009:adverse effects / Q000627:therapeutic use*; D011237:Predictive Value of Tests
chemical_list: D000970:Antineoplastic Agents; D017239:Paclitaxel