Study shows chemo assays improve OS with proper chemo selection

• By AnnikaH
• Reply 3710517
• January 16, 2013 at 9:56 am
• Report post

Very interesting!
Thank you for sharing.
I will send the links to Greg.

Annika

• By Teneo
• Reply 3710645
• January 16, 2013 at 10:35 am
• Report post

Shane,
Greg has threads that talk about this subject. Two private companies :Rational Therapeutics and Weisenthal Cancer Group do Chemo Assay testing on live tumor tissue. Both seem to be having great success with targeted chemo.

I also have a link to a forum it seems he moderates.
cancerfocus.org

This is a link to an article by Robert A. Nagourney, M.D

http://cancerfocus.org/new_clinical_study_shows_test_that_doubles_chemother apy_response_rate/46729?s=0c997167057534b4a0fce4a69a28c62b&

It is fascinating info on cancer.

• By stage4survivor
• Reply 3710726
• January 16, 2013 at 10:58 am
• Report post

Assays need to become SOP and covered by insurance.

There's a strong case for willful neglect or malpractice to forego this test if a sample can be retrieved.

I'd make damn sure my docs and insurance company were "on notice" if I was being treated today!

G

• By roosty
• Reply 3710783
• January 16, 2013 at 11:13 am
• Report post

We are aware of Rational Therapuetics and Weisenthal. It's nice to see a study support what many on Inspire believe to be true, assays work.

When we come to a need for a change in my dad's treatment we will have an assay done.

I do hope assays become normal operating procedure. When someone is first diagnosed you just want to get them started on a treatment. It was difficult for me to know what approach was best for my dad, chemo, what chemo, apricot seeds, some other naturalistic approach. In the end I felt chemo was best as it had the best data showing it had a benefit.

In those first few weeks of wanting to know what to do it's hard to go against conventional wisdom of chemo and studies show chemo is effective for some, but not all. I believe a chemo assay would change that.

• By AnnikaH
• Reply 3711196
• January 16, 2013 at 1:28 pm
• Report post

Hey you,
I have emailed with Greg re this.
Here is what he has to say on this subject:

"What is missing in the article is that DiaTech is NOT the only one on the market that can tell an oncologist the most effective chemotherapy treatment for the patient.

They have also claimed that they are the only commercial pathology reference laboratory in the U.S. that works exclusively with "live" cancer cells and the only one that has the expertise and technology to measure drug sensitivity of specific cancer cells.

Perhaps they are making this misleading claim because they are licensed as a pathology laboratory, while other laboratories have been pigeonholed as immunology laboratories by the FDA.

DiaTech Oncology uses the MiCK assay which is their "brand name" for a caspases assay (caspase-mediated apoptosis). It correlates precisely with the findings in the DISC, MTT and ATP assays.

Following the description of apoptosis in the British Journal of Cancer in 1972, scientists around the world incorporated the concept of programmed cell death into their cancer research. What is less understood is the fact that apoptosis is not synonymous with programmed cell death.

Programmed cell death is a fundamental feature of multicellular organism biology. Mutated cells incapable of performing their normal functions self-destruct in service of the multicellular organism as a whole.

While apoptosis represents an important mechanism of programmed cell death, it is only one of several cell death pathways.

Apoptotic cell death occurs with certain mutational events, DNA damage, oxidative stress and withdrawal of some growth factors particularly within the immune system.

Non-apoptotic programmed cell death includes: programmed necrosis, para-apoptosis, autophagic cell death, nutrient withdrawal, and subtypes associated with mis-folded protein response, and PARP mediated cell death.

While apoptotic cell death follows a recognized cascade of caspase mediated enzymatic events, non-apoptotic cell death occurs in the absence of caspase activation.

With the recognition of programmed cell death as a principal factor in carcinogenesis and cancer response to therapy, there has been a growing belief that the measurement of apoptosis alone will provide the insights needed in cancer biology. This oversimplification underestimates the complexity of cell biology and suggests that cancer cells have but one mechanisms of response to injury.

It has previously been shown that cancer cells that suffer lethal injury and initiate the process of apoptosis can be treated with caspase inhibitors to prevent caspase-mediated apoptosis. Of interest, these cells are not rescued from death. Instead, these cells committed to death, undergo a form of non-apoptotic programmed cell death more consistent with necrosis. Thus, commitment to death overrides mechanism of death.

Labs that focus on measurements of caspase activation can "only" measure apoptotic cell death. While apoptotic cell death is of importance in hematologic cancers and some solid tumors, it does not represent the mechanism of cell death in all tumors.

While caspase activation is of interest, comparably easy to measure and useful in many leukemias and lymphomas, it does not represent cancer cell death in all circumstances and can be an unreliable parameter in many solid tumors.

Laboratories that measure only one mechanism of cell death (e.g. caspase activation as a measure of apoptosis) miss important cell responses that are critical to the accurate prediction of clinical response."


Annika

• By roosty
• Reply 3711297
• January 16, 2013 at 2:01 pm
• Report post

So, it's not bad but not as complete as RT is my interpretation?
And Diatech perhaps misrepresents the availability of chemo assay testing.

• By mehitabel
• Reply 3711466 · In reply to 3711196 by AnnikaH
• January 16, 2013 at 2:59 pm
• Report post

I like the subject of cell death...and the work of Matzinger. It's immune system related.
Some of greg's thoughts should be attributed.

http://robertanagourney.wordpress.com/2010/04/15/forms-of-cell-death/


ron

• By slimesnake
• Reply 3711623
• January 16, 2013 at 4:05 pm
• Report post

When will the insurance companies and Medicare wake up and pressure the FDA to accept sen/resis assays? The Ovarian wing of ASCO now agrees. And when will the oncs mantra of "take the coolaid and shut up and stay away from anti-oxidants because chemo is an oxidative process" fade.

I recently read a study of my chemo Gemzar and the potentiating effect of cucumin and cucumin analogs on pancreatic cell lines. And guess where they sourced both the Gemzar, curcumin and cucumin analogs - Eli Lilly & Co!!! So Big Pharma knows that phytochemicals from nature can potentiate or sensitize tumors and cancer cells to both chemo and radiation, and are looking for ways to develop patentable ($$$$) nanoparticle analogs and delivery systems, but meanwhile our oncs armed with nothing but a theoretical precept continue to prattle on with detriment to their patients, especially Stage IVs who have nothing to lose and maybe a lot to gain. JMHO.

• By AnnikaH
• Reply 3711922 · In reply to 3711466 by mehitabel
• January 16, 2013 at 5:47 pm
• Report post

Ron,
You are right on.

Roosty- I agree.

S-snake,
Yep, that is right. It is quite interesting that they will agree to the concept when it applies to ovarian cancer but not others?
However, the optimist in me believes we are at a crossroads with cancer treatments and the view of recurring cancer and also presenting III-IV. We see more and more oncs stepping out of the box, going for the cure when in the past they would have dismissed the patient with some coolaid. Trimodality treatmetns are employed, surgical techniques have improved and they are able to operate on more fragile tissue, more complicated scenarios. Radaition treatmetns have also improved and they are getting better results with less collateral damage. On top of that we have the targeted treatments today and also- the assay testing(s). It is slow moving but it IS moving.

Oy sorry, I must be in a very good mood. Maybe because I just visited with my new grand daughter?

I have to introduce her in a separate post.

All my best to you guys.

Annika

• By dolcinia
• Reply 3712086
• January 16, 2013 at 6:50 pm
• Report post

Thanks for starting the thread Roosty, and to all who contributed to it, and especially to you Nika for getting Greg's overview to us. Amazing how we can make Inspire work smoothly even with roadblocks that have been set up to detour us.

I really appreciated Greg's analysis of the original article, and it's the first time that I realized that there are different classifications of labs.....i.e., pathology and immunology labs.

I've always thought that Slimesnake's observation about certain herbs, spices & natural substances, being able to augment chemo response (rather than interfere with it) has to be true. It HAS to be. I've been controlling limb-girdle muscular dystrophy for 2 decades and now Stage 4 lung cancer with just natural biologicals for 5 years now. So far-so good.

So, a big thanks to all, and congrats to you Annika on the birth of your beautiful new granddaughter!

Keep the quest for knowledge alive,
Best wishes,
Cyn

• By slimesnake
• Reply 3712191
• January 16, 2013 at 7:29 pm
• Report post

Annika,

Nothing wrong with optomism, especially witnessing your own genes renewed. Congrats on the new little one.

I agree that the rapid progress in radiology treatment is very hopeful and exciting. I often read Stage IV folks describe their presentation and think to myself, that individual might be saved by allopathic means! Unfortuneately Stage IV folks, and even many IIIs, are looked at today as not being "cost effective." Given the fiscal climate, I'm afraid that will not change very soon.

• By AnnikaH
• Reply 3712232 · In reply to 3712191 by slimesnake
• January 16, 2013 at 7:43 pm
• Report post

Thank you SS and Cyn,
Cost effective? You know how inflated these "costs" are, right?
All I have to do is look at my insurance statements,
Holy cow. You are right. I am absolutely not cost effective!

:)

• By starcitychef
• Reply 3713206
• January 17, 2013 at 5:11 am
• Report post

Where's Greg? I've been incommunicado for a while, but now realize that his name has disappeared from my friends list?
~ Joyce

• By CraiginPA
• Reply 3716282
• January 18, 2013 at 4:12 am
• Report post

This seems to be DiaTech marketing hype about the first study of this branded version of chemosensitivity testing. There are only 6 NSLCL patients in the study, which is to small to draw any conclusions from, and it cannot be assumed that all cancers are alike. It is clearly wrong or misleading it its claim of being the only such test available. (Maybe it is distinct by being available for resale for use by local labs???)

The most likely reason insurance companies don't accept the R.T. (et al) approach is that there aren't any randomized controlled studies. There are only studies on pre-selected patients (those seeking the test), so it is hard to make comparisons to statistics from other studies. The studies that do exist suggest about 2/3 odds of correctly predicting chemosensitivity. It is unknown whether that is a lot better than what oncologists would choose normally. My personal wild guess is that it isn't a lot better for 1st line chemo, but might get a lot better as one tries additional lines of chemo later (with declining odds of effectiveness), but a phase 3 randomized controlled trial would be needed to determine that.

If I were having surgery for another reason anyway, I'd consider getting a functional assay regardless. But in my case I don't think I'd get surgery just to get a big enough live tissue sample, creating a risk of enabling some cancer cells to escape to elsewhere. (My cancer is confined to my lungs so far and I'd prefer it stay that way.)

Best hopes,