Anyone ever heard of tumor profiling or Rational Therapeutics?

artteacher

Does anyone know anything about testing the actual tumor to determine which chemo will work?  I went through 3 of 6 rounds of neoadjuvant chemotherapy (TAC) when I realized that not only was my tumor not shrinking, but was growing (began at about 3 cm, when removed was 4.8).  Sometimes it pays to be flat chested!  I called my doc and he wanted an MRI asap.  This is where I was proven correct.  Apparently I am in the 1-2% category where my particular regiment of chemo for my particular cancer does NOT work.  As anyone would be, I was very upset. 

Anyway and needless to say, the chemo stopped and surgery was scheduled (had it 10 days ago).  My doc suggested I have the tumor sent to a lab in California called Rational Therapeutics.  Here they test the tumor and find out which regiments of chemo it is resistant to and which will kill it.  To me, this sounds like something that should be done with each and every cancer, but it is rarely done.  Of course, I agreed.  Anyone ever done this?  What were your results?

I'm so thankful I did the chemo prior to surgery, otherwise I would have had surgery, then done the six rounds of TAC, and never known it did not work.  I'm also thankful that, amazingly, the cancer had not spread to the nodes, even being a grade 3.  That was nothing but answered prayer.

www.pattihatescancer.blogspot.com

toomuch

I just sent you a private message (PM).

amy

squidwitch42

Patti,

Thank you for your story. I wonder in retrospect why we did not do chemo first as mine was close to the chest wall. Or maybe that's why we did surgery first? I'm glad you are being pro-active, and sharing your story so others can learn. Will you please let us know how it goes for you?

Traci

Gitane

I had it.  If you would like to know specifics, please PM me.  I think it's a good thing.  G.

artteacher

Thanks, Traci,

I'm so glad I have a doctor who suggested this lab.  He has met Dr. Nagourney from Rational Therapeutics and says he is a genius.  My tumor was sent the them the day of my surgery, Oct. 27, and they have already emailed me the results.  Unfortunately, I don't read Greek, so am looking forward to seeing my doctor later this week for removal of staples and drain (I hope) and will get his take on the matter.  I'm sure the next stop is back to my onco for more chemo. I'll post something more when I know what's next.  Best wishes to you.

Patti

gpawelski

What is the precedent for using cell culture assay tests?

There isn't one paper, or two, which by itself, makes a case for or against cell-based assays. Nor does the proposition that the whole thing depends on one study or even one review. You've got to consider the body of literature as a whole.

The fact that none of this exists as one neat, convenient paper in the New England Journal of Medicine does not, in any way, negate the existence of this body of information. It has been found that newer methods of "cell-death" assays have an overall predictive accuracy of 98.2% concerning treatment response, which compares favorably with older, previously published data ranging from 75% to 92%. (Staib,P.et al. Br J Haematol 128 (6):783-781, March 2005)

We have tests such as estrogen receptor, progesterone receptor, Her2/neu, BCR-ABL, C-KIT, CD-20, etc., and panels of immunohistochemical stains for subclassifying tumors. All of these tests are used to select chemotherapy in precisely the same manner as cell culture assay tests are used.

Also, we have the use of additional medical tests, such as serial CT, MRI, and PET scans, performed for the purpose of monitoring the size of the tumor to determine if it is shrinking or growing with chemotherapy. The purpose of this testing is to determine if chemotherapy with specific drugs should be continued or changed to different drugs. These radiographic tests are also used as an aid in making clinical decisions about the choice of chemotherapy.

So yes, there is precedent for using cell culture assays.

What research scientists in universities and cancer centers have been doing for the past ten years is trying to figure out a way to use molecular profiling to look for patterns of gene expression which correlate with and predict for the activity of anticancer drugs. However, genes do not operate alone within the cell but in an intricate network of interactions.

Examing a patient's DNA can give physicians a lot of information, but as the NCI has concluded (J Natl Cancer Inst. March 16, 2010), it cannot determine treatment plans for patients. It cannot test sensitivity to any of the targeted therapies. They just test for "theoretical" candidates for targeted therapy.

Cancer cells utilize cross talk and redundancy to circumvent therapies. They back up, zig-zag and move in reverse, regardless of what the sign posts say. The building blocks of human biology are carefully construed into the complexities that we recognize as human beings.

However appealing gene profiling may appear to those engaged in this field, it will be years, perhaps decades, before these profiles can approximate the vagaries of human cancer.

Laboratories like Rational Therapeutics and Weisenthal Cancer Group test for a lot more than just a few mutations.

The cell is a system, an integrated, intereacting network of genes, proteins and other cellular constituents that produce functions. One needs to analyze the systems' response to drug treatments, not just one or a few targets (pathways).

Their functional profiling test assesses the activity of a drug upon combined effect of all cellular processes, using several metabolic (cell metabolism) and morphologic (structure) endpoints, at the cell "population" level, rather than at the "single cell" level, measuring the interaction of the entire genome.