title: Evaluation of a chemoresponse assay as a predictive marker in the treatment of recurrent ovarian cancer: further analysis of a prospective study.
abstract: BACKGROUND
  Recently, a prospective study reported improved clinical outcomes for recurrent ovarian cancer patients treated with chemotherapies indicated to be sensitive by a chemoresponse assay, compared with those patients treated with non-sensitive therapies, thereby demonstrating the assay's prognostic properties. Due to cross-drug response over different treatments and possible association of in vitro chemosensitivity of a tumour with its inherent biology, further analysis is required to ascertain whether the assay performs as a predictive marker as well.
  
  
  METHODS
  Women with persistent or recurrent epithelial ovarian cancer (n=262) were empirically treated with one of 15 therapies, blinded to assay results. Each patient's tumour was assayed for responsiveness to the 15 therapies. The assay's ability to predict progression-free survival (PFS) was assessed by comparing the association when the assayed therapy matches the administered therapy (match) with the association when the assayed therapy is randomly selected, not necessarily matching the administered therapy (mismatch).
  
  
  RESULTS
  Patients treated with assay-sensitive therapies had improved PFS vs patients treated with non-sensitive therapies, with the assay result for match significantly associated with PFS (hazard ratio (HR)=0.67, 95% confidence interval (CI)=0.50-0.91, P=0.009). On the basis of 3000 simulations, the mean HR for mismatch was 0.81 (95% range=0.66-0.99), with 3.4% of HRs less than 0.67, indicating that HR for match is lower than for mismatch. While 47% of tumours were non-sensitive to all assayed therapies and 9% were sensitive to all, 44% displayed heterogeneity in assay results. Improved outcome was associated with the administration of an assay-sensitive therapy, regardless of homogeneous or heterogeneous assay responses across all of the assayed therapies.
  
  
  CONCLUSIONS
  These analyses provide supportive evidence that this chemoresponse assay is a predictive marker, demonstrating its ability to discern specific therapies that are likely to be more effective among multiple alternatives.
authors.affiliation: Precision Therapeutics, Inc., 2516 Jane Street, Pittsburgh, PA 15203, USA.
authors.forename: C
authors.initials: C
authors.lastname: Tian
authors.affiliation: Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sargent
authors.affiliation: The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Krivak
authors.affiliation: Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Powell
authors.affiliation: Precision Therapeutics, Inc., 2516 Jane Street, Pittsburgh, PA 15203, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gabrin
authors.affiliation: Precision Therapeutics, Inc., 2516 Jane Street, Pittsburgh, PA 15203, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Brower
authors.affiliation: University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Drive, Houston, TX 77030, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Coleman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents