Introduction: Cancer stem-like cells (CSLCs) in primary brain tumors can resist certain chemotherapies, thereby causing relapse of the disease. Thus, development of a test that identifies the most effective chemotherapy management offers great promise for personalized anticancer treatments.
Methods: We have developed an ex vivo ChemoID® assay designed to predict the sensitivity and resistance of CSLCs and bulk of tumor cells of a given patient's solid tumor to a variety of chemotherapy agents by measuring the percentage of cell death. In a retrospective study of five patients with malignancies of the central nervous system, we assessed the correlation between the results the ChemoID® assay and clinical response. Two anaplastic WHO grade-III ependymomas, two IDH-1 negative WHO grade IV glioblastomas, and one medulloblastoma were tested. Tumors were classified as responsive (50-100% cell kill), intermediately responsive (30-50% cell kill), and nonresponsive (0-30% cell kill) to chemotherapy. Treatment selection was blinded to assay results. MRI and CT scan determined response to therapy.
Results: The ChemoID assay performed on the tumor bulk produced a correct prediction in 4 out of 5 cases (p=0.4, Fisher's Exact Test; PPV=75%, NPV=100%) when compared to the drugs received. The same assay performed on the CSLCs produced a correct prediction in all 5 cases (p=0.1, Fisher's Exact Test; PPV=NPV=100%).
Conclusions: An assay such as ChemoID® that measures cell death of CSLCs and bulk of tumor cells appears to be beneficial in selecting specific standard chemotherapy agents ex vivo for patients with malignancies of the central nervous system.
Patient Care: Oncologists face every day many challenges in determining the best course of therapy for an individual cancer patient. The basic problem is that patients with similar diagnoses don’t always respond to the same chemotherapy, schedule, or dose.
With the ChemoID Drug Response assay, oncologists can determine how chemotherapy will impact cancer stem-like cells (CSLCs) and bulk of tumor cells before it impacts cancer patients.
The ChemoID Drug Response Assay helps oncologists discriminate between effective and ineffective chemotherapeutic agents prior to their use in a patient's treatment.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of cancer stem cells in tumor recurrence, 2) Describe the role of the ChemoID Assay in personalized anticancer therapy, 3) Discuss, in small groups, personalized chemotherapy and the rationale behind it.