title: Cancer Stem Cells Sensitivity Assay (STELLA) in Patients with Advanced Lung and Colorectal Cancer: A Feasibility Study.
abstract: BACKGROUND
  Cancer stem cells represent a population of immature tumor cells found in most solid tumors. Their peculiar features make them ideal models for studying drug resistance and sensitivity. In this study, we investigated whether cancer stem cells isolation and in vitro sensitivity assay are feasible in a clinical setting.
  
  
  METHODS
  Cancer stem cells were isolated from effusions or fresh cancer tissue of 23 patients who progressed after standard therapy failure. Specific culture conditions selected for immature tumor cells that express markers of stemness. These cells were exposed in vitro to chemotherapeutic and targeted agents.
  
  
  RESULTS
  Cancer stem cells were extracted from liver metastases in 6 cases (25%), lung nodules in 2 (8%), lymph node metastases in 3 (12.5%) and pleural/peritoneal/pericardial effusion in 13 (54%). Cancer stem cells were successfully isolated in 15 patients (63%), including 14 with lung cancer (93.3%). A sensitivity assay was successfully performed in 7 patients (30.4%), with a median of 15 drugs/combinations tested (range 5-28) and a median time required for results of 51 days (range 37-95).
  
  
  CONCLUSIONS
  The approach used for the STELLA trial allowed isolation of cancer stem cells in a consistent proportion of patients. The low percentage of cases completing the full procedure and the long median time for obtaining results highlights the need for a more efficient procedure.
  
  
  BACKGROUND
  ClinalTrials.gov NCT01483001.
authors.affiliation: Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital, Livorno, Italy.
authors.forename: Manolo
authors.initials: M
authors.lastname: D'Arcangelo
authors.affiliation: Laboratory of Cellular and Molecular Pathophysiology, University of Palermo, Palermo, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Todaro
authors.affiliation: Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital, Livorno, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Salvini
authors.affiliation: Laboratory of Cellular and Molecular Pathophysiology, University of Palermo, Palermo, Italy.
authors.forename: Antonina
authors.initials: A
authors.lastname: Benfante
authors.affiliation: Laboratory of Cellular and Molecular Pathophysiology, University of Palermo, Palermo, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Colorito
authors.affiliation: Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital, Livorno, Italy.
authors.forename: Armida
authors.initials: A
authors.lastname: D'Incecco
authors.affiliation: Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital, Livorno, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Landi
authors.affiliation: Laboratory of Cellular and Molecular Pathophysiology, University of Palermo, Palermo, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Apuzzo
authors.affiliation: Fondazione Ricerca Traslazionale, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rossi
authors.affiliation: Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital, Livorno, Italy.
authors.forename: Spartaco
authors.initials: S
authors.lastname: Sani
authors.affiliation: Laboratory of Cellular and Molecular Pathophysiology, University of Palermo, Palermo, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Stassi
authors.affiliation: Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital, Livorno, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Cappuzzo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000494:pharmacology*; D002469:Cell Separation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology; D004338:Drug Combinations; D004354:Drug Screening Assays, Antitumor / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000187:drug effects* / Q000473:pathology; D010996:Pleural Effusion / Q000473:pathology; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations