Chemosensitivity/Resistance Assay Part of NCCN Guidelines

gdpawel

The National Comprehensive Cancer Network (NCCN) updated the NCCN Clinical Practice Guidelines for Oncology to include the use of chemosensitivity/resistance assays.

The NCCN states that chemosensitivity/resistance assays are being used in some NCCN member institutions for decisions related to future chemotherapy in situations where there are muliple equivalent chemotherapy options available.

Recent studies presented at ASCO and published in the International Journal of Gynecologic Cancer evaluated the association between prediction of response to chemotherapy and progression-free interval and overall survival in ovarian cancer.

The CEO of the Ovarian Cancer National Alliance stated that not only are oncologists recognizing the benefits of using chemosensitivity and resistance assays when faced with equivalent therapeutic options, they are also paving the way for greater support of personalized medicine in oncology.

NCCN Clinical Practice Guidelines in Oncology are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN member institutions.

http://www.medicalnewstoday.com/articles/180642.php

cancer survivor x 4

Hard To Understand
Hello,
I have seen your posts on Inspire.com. What is your deal? I am sure your information is valuable, I just do not understand it and I am going to nursing school. Can you explain it, in less complicated terms. Thank-you, Paula
Are you a doctor?
Are you a lab tech?
Are you a researcher?
Did You loose a loved one to ovarian cancer?

lindaprocopio

Your post came at a perfect time for me!
We have discussed NCCN recommended practices and chemosensitivity and resistance assays at length on the Uterine Cancer Discussion Board, so you have a receptive appreciative audience with me! I am getting a second opinion tomorrow on my next treatment options and the gynecologic oncologist I am meeting with is a proponent of tissue assays. My chemo oncologist doesn't believe that the science is mature enough to use tissue assays for gynecologic cancers, arguing that they are more likely to rule out INEFFECTIVE chemos than suggest what chemo drugs will be effective. I say that's STILL valuable information, because I wouldn't want to add in a drug (like Avastin) that may have awful side affects if I knew it wouldn't work for me personally for my unique cancer.

I looked up my current treatment of weekly 1/3 strength taxol for 1st recurrence in the NCCN Guidelines and was very comforted to see it as a recommended protocol. Please consider posting news like this on the Uterine Cancer Discussion Board. We have many with rare aggressive cancers there that are into research and can 'talk the talk' with any oncologist. Thanks!

gdpawel

lindaprocopio said:

Your post came at a perfect time for me!
We have discussed NCCN recommended practices and chemosensitivity and resistance assays at length on the Uterine Cancer Discussion Board, so you have a receptive appreciative audience with me! I am getting a second opinion tomorrow on my next treatment options and the gynecologic oncologist I am meeting with is a proponent of tissue assays. My chemo oncologist doesn't believe that the science is mature enough to use tissue assays for gynecologic cancers, arguing that they are more likely to rule out INEFFECTIVE chemos than suggest what chemo drugs will be effective. I say that's STILL valuable information, because I wouldn't want to add in a drug (like Avastin) that may have awful side affects if I knew it wouldn't work for me personally for my unique cancer.

I looked up my current treatment of weekly 1/3 strength taxol for 1st recurrence in the NCCN Guidelines and was very comforted to see it as a recommended protocol. Please consider posting news like this on the Uterine Cancer Discussion Board. We have many with rare aggressive cancers there that are into research and can 'talk the talk' with any oncologist. Thanks!

Chemosensitivity/Resistance Assays
Linda

There are two major cell-based assay technologies.

Cell-growth (proliferation) assay is performed by growing a portion of the cancer tumor specimen in the presence of different chemotherapy drugs in the laboratory. If cancer cells grow in the presence of a very high dosage of a chemotherapy drug, the cancer is unlikely to respond to that drug in the patient's body. Like you say, by eliminating "inactive" drugs from the therapy regime, the use of this assay avoids exposing patients to the toxicity of those drugs that are "unlikely" to be effective in treating the cancer. The results are to be used only for the purpose of drug "de-selection" and not for drug "selection."

Way back then (over twenty years ago) the goal of cancer treatment was to inhibit unregulated cell "growth." In the last twenty years, the goal is to induce cell "death" in order to successfully conquer cancer. The much older cell-growth assays measured a drug's ability to inhibit cell growth and only succeeds in eliminating drugs that would "not" work for a patient. The more more modern cell-death assays measure the ability of chemotherapy drugs to induce cell "death" (apoptosis) in a tumor specimen from a patient.

The cell-death assays are not growing anything. They are testing a drug or combinations of drugs with cells that are in their natural state (live or fresh). Three dimensional (3D) tumor cell clusters. Clusters maintain natural cell-cell interactions. This makes the assays indicative of what will happen in the body (where the old technology sometimes did not). The protocol takes "fresh" patient tumor cells and floats them in newer 3D cell suspensions. As our body is 3D, not 2D in form, undoubtedly, this novel step better replicates that of the human body. Traditionally, in-vitro (in lab) cell-lines have been studied in 2 dimensions (2D) which has inherent limitations in applicability to real life 3D in-vivo (in body) states. Recently, researchers have pointed to the limitations of 2D cell line study and chemotherapy to more correctly reflect the human body.

Most patients are treated with a combination of drugs. When correlating various cell-death assays, the "whole cell" is profiled (entire genome), assessing the activity of a drug (or combinations) upon combined effect of all cellular processes, using several metabolic and morphologic endpoints. This is more important than using tests which identify DNA or RNA sequences or gene expression of individual proteins that often examine only one component of a much larger, interactive process (you've heard about Her2, EGFR, VEGF, etc).

Most likely, the reason your oncologist may not believe the science is mature enough to use maybe NCI's failure at studying assay-directed therapy. I won't go into detail about it right here (you can read about it on the Inspire ovarian site), but good review papers exist on cell-based, cell-death assays and are increasingly appreciated, understood and applied by the private sector and European clinicians and scientists. The literature on these assays have not been understood by many NCI investigators and by NCI-funded university investigators, because their knowledge was almost always geared towards an assay technique (cell-growth) that hasnt' been used in private labs for over twenty years now.

cancer survivor x 4

I realized this technology is hard to understand. Think what it was like to research and study it over the last ten years. I was a spouse/caregiver to an ovarian cancer patient. I became intensely interested in cancer medicine by virtue of working through, enduring and surviving my wife's illness. My college education and experience helped me to gather knowledge by virtue of voluminous reading and hundreds of hours of past and ongoing personal communications with noted authorities and experts in the field.

Although retired, privately, I've been a cancer patient advocate and a researcher of cell function analysis for a number of years, like anyone would have an interest in molecular science or biological science. I do not have any financial conflicts of interest raising the awareness of this technology. My point with respect to this systematic procedure is to educate patients and others (even doctors) that such techniques exist and might be very valuable.

gdpawel

gdpawel said:

Chemosensitivity/Resistance Assays
Linda

There are two major cell-based assay technologies.

Cell-growth (proliferation) assay is performed by growing a portion of the cancer tumor specimen in the presence of different chemotherapy drugs in the laboratory. If cancer cells grow in the presence of a very high dosage of a chemotherapy drug, the cancer is unlikely to respond to that drug in the patient's body. Like you say, by eliminating "inactive" drugs from the therapy regime, the use of this assay avoids exposing patients to the toxicity of those drugs that are "unlikely" to be effective in treating the cancer. The results are to be used only for the purpose of drug "de-selection" and not for drug "selection."

Way back then (over twenty years ago) the goal of cancer treatment was to inhibit unregulated cell "growth." In the last twenty years, the goal is to induce cell "death" in order to successfully conquer cancer. The much older cell-growth assays measured a drug's ability to inhibit cell growth and only succeeds in eliminating drugs that would "not" work for a patient. The more more modern cell-death assays measure the ability of chemotherapy drugs to induce cell "death" (apoptosis) in a tumor specimen from a patient.

The cell-death assays are not growing anything. They are testing a drug or combinations of drugs with cells that are in their natural state (live or fresh). Three dimensional (3D) tumor cell clusters. Clusters maintain natural cell-cell interactions. This makes the assays indicative of what will happen in the body (where the old technology sometimes did not). The protocol takes "fresh" patient tumor cells and floats them in newer 3D cell suspensions. As our body is 3D, not 2D in form, undoubtedly, this novel step better replicates that of the human body. Traditionally, in-vitro (in lab) cell-lines have been studied in 2 dimensions (2D) which has inherent limitations in applicability to real life 3D in-vivo (in body) states. Recently, researchers have pointed to the limitations of 2D cell line study and chemotherapy to more correctly reflect the human body.

Most patients are treated with a combination of drugs. When correlating various cell-death assays, the "whole cell" is profiled (entire genome), assessing the activity of a drug (or combinations) upon combined effect of all cellular processes, using several metabolic and morphologic endpoints. This is more important than using tests which identify DNA or RNA sequences or gene expression of individual proteins that often examine only one component of a much larger, interactive process (you've heard about Her2, EGFR, VEGF, etc).

Most likely, the reason your oncologist may not believe the science is mature enough to use maybe NCI's failure at studying assay-directed therapy. I won't go into detail about it right here (you can read about it on the Inspire ovarian site), but good review papers exist on cell-based, cell-death assays and are increasingly appreciated, understood and applied by the private sector and European clinicians and scientists. The literature on these assays have not been understood by many NCI investigators and by NCI-funded university investigators, because their knowledge was almost always geared towards an assay technique (cell-growth) that hasnt' been used in private labs for over twenty years now.

cancer survivor x 4

I realized this technology is hard to understand. Think what it was like to research and study it over the last ten years. I was a spouse/caregiver to an ovarian cancer patient. I became intensely interested in cancer medicine by virtue of working through, enduring and surviving my wife's illness. My college education and experience helped me to gather knowledge by virtue of voluminous reading and hundreds of hours of past and ongoing personal communications with noted authorities and experts in the field.

Although retired, privately, I've been a cancer patient advocate and a researcher of cell function analysis for a number of years, like anyone would have an interest in molecular science or biological science. I do not have any financial conflicts of interest raising the awareness of this technology. My point with respect to this systematic procedure is to educate patients and others (even doctors) that such techniques exist and might be very valuable.

Chemosensitivity and chemoresistance testing in ovarian cancer
Chemosensitivity and chemoresistance testing in ovarian cancer

Ian A. Cree
Translational Oncology Research Centre, Queen
Alexandra Hospital, Portsmouth, UK
Correspondence to Ian A Cree, MBChB, PhD,
FRCPath, Translational Oncology Research Centre,
Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
Current Opinion in Obstetrics and Gynecology
2009, 21:39–43

Purpose of review

Sensitivity testing in ovarian cancer to individualize therapy remains an active area of interest and this has been renewed recently by results from several groups. The clinical results of assay-directed therapy are invariably better than would be expected from empirical treatment, but it has proved difficult to get these tests into practice.

Recent findings

Several recent studies suggest that cellular individualized tumour response tests, particularly the ATP-based tumour chemosensitivity assay, can improve the chance of response and probably survival for individual patients. Most tumour response tests show excellent correlation with clinical resistance, but vary in their ability to predict sensitivity. Molecular assays of sensitivity and resistance are less developed in ovarian cancer than in breast cancer, but those using multiple gene signatures show considerable promise.

Summary

Individualized therapy has the ability to guide the use of chemotherapy as well as newer agents. The development of companion diagnostics for drugs used in ovarian cancer has considerable potential for the future and such assays are already proving useful where there is clinical evidence of equivalence between possible treatments.

Conclusion

Clearly one size does not fit all when it comes to cancer treatment, but individualized therapy needs predictive tests to tailor treatment to individual patients. The requirement for such information is new to many pathologists,who tend to think that the job has been done when the diagnosis has been made, and many of the tests available have been developed by motivated researchers working in a variety of settings. It is also difficult to persuade health care managers and politicians of the value of expensive new drugs unless these are matched by considerable improvements in patient survival. Targeting drugs makes good economic sense and patients avoid the side effects of drugs from which they are unlikely to benefit.

The problem of which test to use is still an issue. For some patients, obtaining the amount of tissue required for cellular sensitivity testing requires surgery, which may not be otherwise indicated. Molecular methods may require less cancer tissue, but are often (currently) limited to the assessment of a relatively small number of drugs.

The need for predictive tests is greatest when there is a need to make a treatment decision. In the past, when in some countries guidance only allowed platinum chemotherapy for the treatment of primary ovarian cancer, there was little point in testing such tumours. Chemotherapy leads to adaptation of surviving cells to the drugs used, and cross-resistance to other drugs, depending upon which mechanisms of resistance the cancer cell uses. The problem then becomes one of selecting second-line therapy – and the oncologist has a number of roughly equivalent options from which to choose. Any assistance at this point is usually welcome, and a predictive assay would be very useful.

The failure of the GOG-0182/ICON5 trial to show selective advantage between five arms using different regimens means that primary ovarian cancer is now ready for a clinical trial of sensitivity testing. The question to be answered is whether all those who responded in one arm of the GOG-0182/ICON5 trial would also have responded in another. Crossover data from many previous trials tends to suggest that this is unlikely, and chemoresponse testing provides strong scientific evidence to support the idea that responders in one arm might not have done so well in another arm of the study. It is, therefore, likely that patients will do better if chemoresponse testing is used to provide evidence of the individual likelihood of response to any treatment proposed.

http://v.doing-times.com/doc/pdf/tms/wenxian/Chemosensitivity and chemoresistance testing in ovarian cancer.pdf

groundeffect

cancer survivor x 4 said:

Hard To Understand
Hello,
I have seen your posts on Inspire.com. What is your deal? I am sure your information is valuable, I just do not understand it and I am going to nursing school. Can you explain it, in less complicated terms. Thank-you, Paula
Are you a doctor?
Are you a lab tech?
Are you a researcher?
Did You loose a loved one to ovarian cancer?

Your questions are valid
Paula,

Your questions are valid, and I would recommend anyone to whom this testing is recommended ask the doctor (if that is who recommends it) if they have any financial interest in the company doing the testing.

The oncologist who did my surgery eight years ago recommended it, and the invoice for the service was breathtaking (and our responsibility). After investigating the testing company, we found that the doctor was involved with the company.

gdpawel

gdpawel said:

Chemosensitivity and chemoresistance testing in ovarian cancer
Chemosensitivity and chemoresistance testing in ovarian cancer

Ian A. Cree
Translational Oncology Research Centre, Queen
Alexandra Hospital, Portsmouth, UK
Correspondence to Ian A Cree, MBChB, PhD,
FRCPath, Translational Oncology Research Centre,
Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
Current Opinion in Obstetrics and Gynecology
2009, 21:39–43

Purpose of review

Sensitivity testing in ovarian cancer to individualize therapy remains an active area of interest and this has been renewed recently by results from several groups. The clinical results of assay-directed therapy are invariably better than would be expected from empirical treatment, but it has proved difficult to get these tests into practice.

Recent findings

Several recent studies suggest that cellular individualized tumour response tests, particularly the ATP-based tumour chemosensitivity assay, can improve the chance of response and probably survival for individual patients. Most tumour response tests show excellent correlation with clinical resistance, but vary in their ability to predict sensitivity. Molecular assays of sensitivity and resistance are less developed in ovarian cancer than in breast cancer, but those using multiple gene signatures show considerable promise.

Summary

Individualized therapy has the ability to guide the use of chemotherapy as well as newer agents. The development of companion diagnostics for drugs used in ovarian cancer has considerable potential for the future and such assays are already proving useful where there is clinical evidence of equivalence between possible treatments.

Conclusion

Clearly one size does not fit all when it comes to cancer treatment, but individualized therapy needs predictive tests to tailor treatment to individual patients. The requirement for such information is new to many pathologists,who tend to think that the job has been done when the diagnosis has been made, and many of the tests available have been developed by motivated researchers working in a variety of settings. It is also difficult to persuade health care managers and politicians of the value of expensive new drugs unless these are matched by considerable improvements in patient survival. Targeting drugs makes good economic sense and patients avoid the side effects of drugs from which they are unlikely to benefit.

The problem of which test to use is still an issue. For some patients, obtaining the amount of tissue required for cellular sensitivity testing requires surgery, which may not be otherwise indicated. Molecular methods may require less cancer tissue, but are often (currently) limited to the assessment of a relatively small number of drugs.

The need for predictive tests is greatest when there is a need to make a treatment decision. In the past, when in some countries guidance only allowed platinum chemotherapy for the treatment of primary ovarian cancer, there was little point in testing such tumours. Chemotherapy leads to adaptation of surviving cells to the drugs used, and cross-resistance to other drugs, depending upon which mechanisms of resistance the cancer cell uses. The problem then becomes one of selecting second-line therapy – and the oncologist has a number of roughly equivalent options from which to choose. Any assistance at this point is usually welcome, and a predictive assay would be very useful.

The failure of the GOG-0182/ICON5 trial to show selective advantage between five arms using different regimens means that primary ovarian cancer is now ready for a clinical trial of sensitivity testing. The question to be answered is whether all those who responded in one arm of the GOG-0182/ICON5 trial would also have responded in another. Crossover data from many previous trials tends to suggest that this is unlikely, and chemoresponse testing provides strong scientific evidence to support the idea that responders in one arm might not have done so well in another arm of the study. It is, therefore, likely that patients will do better if chemoresponse testing is used to provide evidence of the individual likelihood of response to any treatment proposed.

http://v.doing-times.com/doc/pdf/tms/wenxian/Chemosensitivity and chemoresistance testing in ovarian cancer.pdf

Chemosensitivity vs Chemoresistance
A published study in ovarian cancer raised the question of the distinction between "chemosensitivity" and "chemoresistance" (drug resistance). The distinctions are largely semantic and not of useful clinical relevance. Resistance is the relative absence of sensitivity and sensitivity is the relative absence of resistance.

The Matsuo, et al study (Int J Cancer. 2009 Dec 1;125(11):2721-7) and another study presented at the 2009 ASCO meeting (J Clin Oncol 27:15s, 2009 suppl; abstr 5504) showed no useful correlation between the "extreme drug resistance" (cell-growth assay) endpoint and any clinical outcome in ovarian cancer. While the Matsuo, et al study showed highly significant correlations between the chemosensitive (cell-death assay) endpoint and both progression-free and overall survival.

Several things are evident:

1. In all individual studies, patients treated with drugs classified as “sensitive” had a higher response rate than that for all the patients in each individual study.

2. In all individual studies, patients treated with drugs classified as “resistant” had a lower response rate than that for all the patients in each individual study.

3. In all individual studies, patients treated with drugs classified as “sensitive” had a "much" higher response rate than for patients treated with drugs classified as “resistant.”

4. Averaging up all of the studies, patients treated with drugs classified as “sensitive” had an 8-fold higher response rate than patients treated with drugs classified as “resistant.”

All of the above data point to the fact that differences between “chemosensitivity” and “chemoresistance” are entirely semantic and that the proper role for these assays is to direct attention towards agents in the “sensitive” (“low resistance”) group and away from agents in the “resistant” (“low sensitivity” group).

When clinically relevant and accepted drugs may have the same efficacy, and a tumor is "resistant" to one of them, it is within the standard of care to give the drug with the least "resistance" and/or the drug with the most "sensitivity."

My personal belief is in having additional support of drug patient-specific activity as determined by extensive laboratory pre-tests to bolster the clinical justification of the drug(s) chosen, with no economic ties to outside healthcare organizations; recommendations made without financial or scientific prejudice.

http://www.ncbi.nlm.nih.gov/pubmed/19530239?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=65&abstractID=32065

lindaprocopio

gdpawel said:

Chemosensitivity vs Chemoresistance
A published study in ovarian cancer raised the question of the distinction between "chemosensitivity" and "chemoresistance" (drug resistance). The distinctions are largely semantic and not of useful clinical relevance. Resistance is the relative absence of sensitivity and sensitivity is the relative absence of resistance.

The Matsuo, et al study (Int J Cancer. 2009 Dec 1;125(11):2721-7) and another study presented at the 2009 ASCO meeting (J Clin Oncol 27:15s, 2009 suppl; abstr 5504) showed no useful correlation between the "extreme drug resistance" (cell-growth assay) endpoint and any clinical outcome in ovarian cancer. While the Matsuo, et al study showed highly significant correlations between the chemosensitive (cell-death assay) endpoint and both progression-free and overall survival.

Several things are evident:

1. In all individual studies, patients treated with drugs classified as “sensitive” had a higher response rate than that for all the patients in each individual study.

2. In all individual studies, patients treated with drugs classified as “resistant” had a lower response rate than that for all the patients in each individual study.

3. In all individual studies, patients treated with drugs classified as “sensitive” had a "much" higher response rate than for patients treated with drugs classified as “resistant.”

4. Averaging up all of the studies, patients treated with drugs classified as “sensitive” had an 8-fold higher response rate than patients treated with drugs classified as “resistant.”

All of the above data point to the fact that differences between “chemosensitivity” and “chemoresistance” are entirely semantic and that the proper role for these assays is to direct attention towards agents in the “sensitive” (“low resistance”) group and away from agents in the “resistant” (“low sensitivity” group).

When clinically relevant and accepted drugs may have the same efficacy, and a tumor is "resistant" to one of them, it is within the standard of care to give the drug with the least "resistance" and/or the drug with the most "sensitivity."

My personal belief is in having additional support of drug patient-specific activity as determined by extensive laboratory pre-tests to bolster the clinical justification of the drug(s) chosen, with no economic ties to outside healthcare organizations; recommendations made without financial or scientific prejudice.

http://www.ncbi.nlm.nih.gov/pubmed/19530239?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=65&abstractID=32065

Can you help me understand my new pathology report?
I recently had my original tissue slides from my Oct. 2008 hysteretomy reviewed by a different pathologist. (I did this because they were suggesting Magace or Tamoxifen as a treatment for me, and I didn't think my cancer had been documented as hormone receptive in any way.)

This new pathology report says my cancer cells are "moderately positive for estrogen receptor" (meaning that I could take Megace or tamoxifen as an alternative to chemo as treatment options??). It also says my cancer cells were/are "strongly CK7 positive"; "Weakly vimentin and p53 positive"; "progesterone receptor negative and WT-1 negative."

Could you help me to understand what any of that means? The soonest I could get an apppointment wit my gyne-onc to talk about the new pathology report is May 24th, since he wants me to have a CT/PET and CA125 done prior to seeing me (scan will be May 17th) to also factor into my upcoming treatment decision. You seem so knowledgeable that I thought you might be able to help me translate this medical jargon.

My plan is to have tissue assays done if I need to have any more surgery, as I fear my cancer cells have mutated since 2008, with the 28 rounds of radiation and 18 rounds of chemo I've had since then.

gdpawel

lindaprocopio said:

Can you help me understand my new pathology report?
I recently had my original tissue slides from my Oct. 2008 hysteretomy reviewed by a different pathologist. (I did this because they were suggesting Magace or Tamoxifen as a treatment for me, and I didn't think my cancer had been documented as hormone receptive in any way.)

This new pathology report says my cancer cells are "moderately positive for estrogen receptor" (meaning that I could take Megace or tamoxifen as an alternative to chemo as treatment options??). It also says my cancer cells were/are "strongly CK7 positive"; "Weakly vimentin and p53 positive"; "progesterone receptor negative and WT-1 negative."

Could you help me to understand what any of that means? The soonest I could get an apppointment wit my gyne-onc to talk about the new pathology report is May 24th, since he wants me to have a CT/PET and CA125 done prior to seeing me (scan will be May 17th) to also factor into my upcoming treatment decision. You seem so knowledgeable that I thought you might be able to help me translate this medical jargon.

My plan is to have tissue assays done if I need to have any more surgery, as I fear my cancer cells have mutated since 2008, with the 28 rounds of radiation and 18 rounds of chemo I've had since then.

Cancer Cell Lines vs Fresh Tumor Cells
Linda

If you had your original tissue slides from last year reviewed, they were more than likely preserved in paraffin wax, which made them "passaged" cell-lines compared to your orginal primary, fresh tumors. Established cell-line is not reflective of the behavior of "fresh" live tumor cells.

Established cell-lines have been a huge disappointment over the decades, with respect to their ability to correctly model the disease-specific activity of drugs for cancers. In other words, ovarian cancer cell-lines have proved worthless as models to predict the activity of drugs in ovarian cancer.

Cell-lines are useful for special stains and immunohistochemistry and can give morphological details by preserving the architectural patterns. However, cell-lines are paraffin-embedded and paraffin-embedded tissue can change over time.

gdpawel

Cost Analysis of Chemoresponse Assays
Impact of a chemoresponse assay on treatment costs for recurrent ovarian cancer.

Havrilesky LJ, Krivak TC, Mucenski JW, Myers ER.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, NC.

Objective
We sought to estimate mean costs of chemotherapy treatment for recurrent ovarian cancer with or without use of a chemoresponse assay.

Study design
We estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist's choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.

Results
The most common chemotherapy regimens used were topotecan, doxorubicin, and carboplatin/paclitaxel. Mean chemotherapy costs for 6 cycles were $48,758 (empiric), $33,187 (assay assisted), and $23,986 (assay adherent). The cost savings related to the assay were associated with a shift from higher- to lower-cost chemotherapy regimens and lower use of supportive drugs such as hematopoiesis-stimulating agents.

Conclusion
Assay-assisted chemotherapy for recurrent ovarian cancer may result in reduced costs compared to empiric therapy.

Key words: chemoresponse assay; cost analysis; ovarian cancer

PMID: 20417480

Cindy Bear

gdpawel said:

Cost Analysis of Chemoresponse Assays
Impact of a chemoresponse assay on treatment costs for recurrent ovarian cancer.

Havrilesky LJ, Krivak TC, Mucenski JW, Myers ER.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, NC.

Objective
We sought to estimate mean costs of chemotherapy treatment for recurrent ovarian cancer with or without use of a chemoresponse assay.

Study design
We estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist's choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.

Results
The most common chemotherapy regimens used were topotecan, doxorubicin, and carboplatin/paclitaxel. Mean chemotherapy costs for 6 cycles were $48,758 (empiric), $33,187 (assay assisted), and $23,986 (assay adherent). The cost savings related to the assay were associated with a shift from higher- to lower-cost chemotherapy regimens and lower use of supportive drugs such as hematopoiesis-stimulating agents.

Conclusion
Assay-assisted chemotherapy for recurrent ovarian cancer may result in reduced costs compared to empiric therapy.

Key words: chemoresponse assay; cost analysis; ovarian cancer

PMID: 20417480

pathology
Hi Linda. I don't pretend to have a clue on what any of this means but while doing some research for a friend who has BC, I ran across this web site. I'll try to paste the link for you.
Maybe it will help. I believe the CK7 being positive is a good thing. If it was negative, I think it can indicate presence of certain cancers, i.e. colon, prostate (you don't need to worry about that) or kidney. I hope this helps you.
Good luck with your research. Hugs, Cindy


http://www.allexperts.com/el/Pathology/

sweetcoco

cancer survivor x 4 said:

Hard To Understand
Hello,
I have seen your posts on Inspire.com. What is your deal? I am sure your information is valuable, I just do not understand it and I am going to nursing school. Can you explain it, in less complicated terms. Thank-you, Paula
Are you a doctor?
Are you a lab tech?
Are you a researcher?
Did You loose a loved one to ovarian cancer?

nursing
To Cancer Survivor X:
Please don't take this as an insult. It is not intended as one. All of us have different gifts in life and I feel that the calling of Nursing is a noble one. The field of nursing also comes with great responsibility. After all a nurse has someone's life in their hands. Most people do not have that in their daily job description. If you mess up, someone could die or get very ill. Most of our work mistakes do not affect people's actual lives.

That being said I along with many people on this site probably gasped too read your entry. If you, a student at nursing school cannot understand simple and coherent information about Assay testing, I think you should reconsider nursing as a profession.
You will have individuals lives in your hands and if the information about Assay testing and Chemo/Sensitivity is difficult to understand, please reconsider the nursing field.

I am NOT a nurse, I am an ordinary business woman and knew nothing about Assay testing nor Chemo sensitity before I got cancer, but I had no problem understanding the information.

Please, don't go into nursing.

carolenk

sweetcoco said:

nursing
To Cancer Survivor X:
Please don't take this as an insult. It is not intended as one. All of us have different gifts in life and I feel that the calling of Nursing is a noble one. The field of nursing also comes with great responsibility. After all a nurse has someone's life in their hands. Most people do not have that in their daily job description. If you mess up, someone could die or get very ill. Most of our work mistakes do not affect people's actual lives.

That being said I along with many people on this site probably gasped too read your entry. If you, a student at nursing school cannot understand simple and coherent information about Assay testing, I think you should reconsider nursing as a profession.
You will have individuals lives in your hands and if the information about Assay testing and Chemo/Sensitivity is difficult to understand, please reconsider the nursing field.

I am NOT a nurse, I am an ordinary business woman and knew nothing about Assay testing nor Chemo sensitity before I got cancer, but I had no problem understanding the information.

Please, don't go into nursing.

Give the student nurse a break, please
Sweetcoco

I think you are being unfair to the student nurse. Maybe you have no problem understanding the information (good for you) but that doesn't mean that someone at the level of a student nurse should be an expert in the subject of chemo sensitivity assays.

As a nursing instructor, I think you are out of line with your expectations of someone who is at the student nurse level.

@survivor x 4: Please stay in nursing we need nurses desperately and especially those who are not afraid to ask questions.

Carolen

sweetcoco

carolenk said:

Give the student nurse a break, please
Sweetcoco

I think you are being unfair to the student nurse. Maybe you have no problem understanding the information (good for you) but that doesn't mean that someone at the level of a student nurse should be an expert in the subject of chemo sensitivity assays.

As a nursing instructor, I think you are out of line with your expectations of someone who is at the student nurse level.

@survivor x 4: Please stay in nursing we need nurses desperately and especially those who are not afraid to ask questions.

Carolen

nursing
Is there no testing for basic comprehension before entering nursing, or teaching?

Seriously, if I were a teacher as you claim to be. I would not want a student taking up valuable space in the already impacted nursing programs, if they could not understand that simple paragraph. Please, we don't desperately need any nurse or any teacher for that matter that thinks mediocrity is acceptable

leesag

sweetcoco said:

nursing
Is there no testing for basic comprehension before entering nursing, or teaching?

Seriously, if I were a teacher as you claim to be. I would not want a student taking up valuable space in the already impacted nursing programs, if they could not understand that simple paragraph. Please, we don't desperately need any nurse or any teacher for that matter that thinks mediocrity is acceptable

Board Etiquette
Sweetcoco,

I'm sure that you understand we are all under a tremendous of stress, many of us have had recurrences of OVCA, I myself recently experienced brain metastasis and have had multiple treatments including a craniotomy. The woman you are denigrating has survived two recurrences of two separate types of cancer, hence the survivor x 4 name. She's an amazing woman who has decided to return to school so that she can give back some of the care that she has received. If you feel the need to denigrate those of us who come here for support and need clarification for information, please refrain. I am also a teacher, I don't claim to be one, I AM one and can supply you with my university credentials including my 3.96 GPA, Summa **** Laude credentials.

The entire concept of being a STUDENT is that one is still learning. It's not mediocre to ask questions and request clarification. Many of GDP's posts are full of medical language that we all need some clarification on from time to time.

I sincerely wish you health and happiness. And I also suggest that you stop criticizing teachers and nurses. You have needed both of them in your life. We're not perfect, but most of us have chosen these jobs because we have a calling. I guarantee you that no one enters teaching for the pay or the hours!

Leesa

leesag

leesag said:

Board Etiquette
Sweetcoco,

I'm sure that you understand we are all under a tremendous of stress, many of us have had recurrences of OVCA, I myself recently experienced brain metastasis and have had multiple treatments including a craniotomy. The woman you are denigrating has survived two recurrences of two separate types of cancer, hence the survivor x 4 name. She's an amazing woman who has decided to return to school so that she can give back some of the care that she has received. If you feel the need to denigrate those of us who come here for support and need clarification for information, please refrain. I am also a teacher, I don't claim to be one, I AM one and can supply you with my university credentials including my 3.96 GPA, Summa **** Laude credentials.

The entire concept of being a STUDENT is that one is still learning. It's not mediocre to ask questions and request clarification. Many of GDP's posts are full of medical language that we all need some clarification on from time to time.

I sincerely wish you health and happiness. And I also suggest that you stop criticizing teachers and nurses. You have needed both of them in your life. We're not perfect, but most of us have chosen these jobs because we have a calling. I guarantee you that no one enters teaching for the pay or the hours!

Leesa

lol
It's funny that my SCL honors were censored!



Leesa

Tethys41

sweetcoco said:

nursing
Is there no testing for basic comprehension before entering nursing, or teaching?

Seriously, if I were a teacher as you claim to be. I would not want a student taking up valuable space in the already impacted nursing programs, if they could not understand that simple paragraph. Please, we don't desperately need any nurse or any teacher for that matter that thinks mediocrity is acceptable

I must have missed...
Why are you visiting this board? Just for your information, this board is aimed at serving as an open forum for women who are suffering with a diagnosis of ovarian cancer, and for their caregivers. The forum allows us to exchange information we have learned, express our fears, and receive support. I am quite sure there is some other forum, somewhere, that allows its members to degrade medical professionals, teachers, and students, but this is not the place. Perhaps those who have been criticized by your posts should feel priviledged, as I see you have posted only twice and used both of those opportunities to rip two members, but it isn't really what we come here to read.

LaundryQueen

sweetcoco said:

nursing
Is there no testing for basic comprehension before entering nursing, or teaching?

Seriously, if I were a teacher as you claim to be. I would not want a student taking up valuable space in the already impacted nursing programs, if they could not understand that simple paragraph. Please, we don't desperately need any nurse or any teacher for that matter that thinks mediocrity is acceptable

Wow!
That is really harsh! Have you always been so critical of others? Or did cancer change you?

LQ

Tethys41

LaundryQueen said:

Wow!
That is really harsh! Have you always been so critical of others? Or did cancer change you?

LQ

I'm not sure
LQ,
I'm not sure he, she, or it was even diagnosed with cancer. The profile does not reflect any such information. I think sweetcoco is just here to sell Coach Purses.