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Finding The Best Treatment For Recurrent Ovarian Cancer

gdpawel's picture
Gallion, H. H., W. A. Christopherson, et al.

According to a study by Dr. Holly Gallion, published in the International Journal of Gynecological Cancer (IJGC) researchers using the Chemo FX Assay by Precision Therapeutics, identified which chemo agent would be most lethal to an individual patient's cancer. In the study of 256 women with recurrent ovarian cancer, the time women went before a worsening of their disease was two to three times longer if they were treated with an assay-sensitive drug compared to an assay-resistant drug. The bottom line is the assay is able to predict the patient's response to treatment. The Chemo FX is a (cell-death) assay test. Their study adds to the already large body of evidence of the accuracy of cell culture assays in ovarian cancer.

The assay determines which agents are most potent against a specific tumor and what concentration works best. No more hit or miss in the patient. Armed with that information, the treating physician and patient can proceed with a chemo regimen likely to work right out of the gate and subjecting the patient to less toxicity. If the assay finds that the tumor responds to none of the currently avialable treatments, a patient could then be referred to a clinical trial before a history of less useful treatments rules her out as a clinical trial candidate.

In light of the precious little in the way of guidance from clinical trials with respect to best empiric treatment, oncologists give treatments knowing full well that only a certain percentage of patients will receive a benefit from any given medicine. They subject patients to one combination chemotherapy after another, just going from one journal paper to another journal paper. They need information about the characteristics that predict which patients are more likely to respond well. The empirical approach, which is based on medical journal articles, epidemiology and economics, doesn't tell doctors how to personalize their care to individual patients. Physicians' decisions need to be based on personal experience, clinical insights, and medical training.

Cell culture assay measures the net effect of all processes within the cancer, acting with and against each other in real time, and it tests living cells actually exposed to drugs and drug combinations of interest. Tens of thousands of individual patient specimens are currently being submitted for testing by more than 1,000 clinical oncologists, surgeons and pathologists annually in the U.S. It is certainly each practitioner's prerogative to order these tests. It seems probable that a self-educated oncologist, genuinely on the cutting-edge would tend to be aggressive in actual treatment beyond mere rhetoric, and make use of running tests on a "fresh" tumor specimen before selecting a chemotherapy option.

Gallion, H. H., W. A. Christopherson, et al. (Jan/Feb 2006). "Relationship between ex vivo chemosensitivity assay and progression free interval in ovarian cancer." International Journal of Gynecological Cancer

PubMed lists a paper that reports an increase from 35% to 65% response rate for recurrent ovarian cancer patients when cell culture assay tests were used to select the chemotherapy drugs. The P values (P=.005, etc.) given are measures of the statistical significance of the findings. The smaller the number, the higher the statistical significance. "P" refers to the probability that the finding is due to random chance. So, high P values are bad. P values of 5% or less are deemed to be statistically significant. All of the P values reported in this study indicate that the results are, indeeed, statistically significant.

(Am J Obstet Gynecol. 2003 Nov;189(5):1301-7)

International Journal of Gynecological Cancer (IJGC)