Selection of chemotherapy by ex vivo assessment of tumor sensitivity to cytotoxic drugs: results of a clinical trial.
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.
Berglund
Ake
A
Departments of Oncology, Radiology, and Clinical Immunology, University Hospital, SE-751 85 Uppsala, Sweden.
Glimelius
Bengt
B
Bergh
Jonas
J
Brodin
Ola
O
Fjällskog
Marie-Louise
ML
Hagberg
Hans
H
von Heideman
Anne
A
Larsson
Rolf
R
Tholander
Bengt
B
de la Torre
Manuel
M
Aström
Gunnar
G
Oberg
Kjell
K
Parö
Gunnar
G
Nygren
Peter
P
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
D000970:Antineoplastic Agents; D017239:Paclitaxel