title: Adenosine triphosphate-based chemotherapy response assay (ATP-CRA)-guided platinum-based 2-drug chemotherapy for unresectable nonsmall-cell lung cancer.
abstract: BACKGROUND
  The study investigated correlations between adenosine triphosphate / chemotherapy response assay (ATP-CRA) and clinical outcomes after ATP-CRA-guided platinum-based chemotherapy for unresectable nonsmall-cell lung cancer (NSCLC).
  
  
  METHODS
  The authors performed an in vitro chemosensitivity test, ATP-CRA, to evaluate the chemosensitivities of anticancer drugs such as cisplatin, carboplatin, paclitaxel, docetaxel, gemcitabine, and vinorelbine for chemonaive, unresectable NSCLC. The cell death rate was determined by measuring the intracellular ATP levels of drug-exposed cells compared with untreated controls. A sensitive drug was defined as a drug producing 30% or more reduction in ATP compared with untreated controls. Assay-guided platinum-based 2-drug chemotherapy was given to patients with pathologically confirmed NSCLC.
  
  
  RESULTS
  Thirty-four patients were enrolled. Thirty tumor specimens were obtained by bronchoscopic biopsies and 4 obtained surgically. The median age was 61 years and 27 patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. The response rate was 43.8%. At a median follow-up period of 16.9 months, the median progression-free and overall survivals were 3.6 and 11.2 months, respectively. Patients were dichotomized into the platinum-sensitive (S; 20 patients) and resistant (R; 14 patients) groups. The positive/negative predictive values were 61.1% and 78.6% with a predictive accuracy of 68.8%. Although without significant differences in pretreatment parameters, the S-group showed better clinical response (P=.036), longer progression-free survival (P=.060), and longer overall survival (P=.025).
  
  
  CONCLUSIONS
  Despite using bronchoscopic biopsied specimens, ATP-CRA and clinical outcomes correlated well after assay-guided platinum-based 2-drug chemotherapy for unresectable NSCLC. There was a favorable response and survival in the platinum-sensitive vs resistant groups.
authors: Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, and Department of Division of Hemato-Oncology, National Health Insurance Corp., Ilsan Hospital, Kyonggi-do, Korea.
authors: Yong Wha
authors: YW
authors: Moon
authors: Sung Ho
authors: SH
authors: Choi
authors: Yong Tai
authors: YT
authors: Kim
authors: Joo Hyuk
authors: JH
authors: Sohn
authors: Joon
authors: J
authors: Chang
authors: Se Kyu
authors: SK
authors: Kim
authors: Moo Suk
authors: MS
authors: Park
authors: Kyung Young
authors: KY
authors: Chung
authors: Hyoun Ju
authors: HJ
authors: Lee
authors: Joo-Hang
authors: JH
authors: Kim
mesh_terms: D000255:Adenosine Triphosphate; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D004354:Drug Screening Assays, Antitumor / Q000379:methods; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017671:Platinum Compounds / Q000008:administration & dosage; D011237:Predictive Value of Tests
chemical_list: D017671:Platinum Compounds; D000255:Adenosine Triphosphate