Research to determine effects of chemo drugs on specific tumors

[VJSabb]

When a cancerous tumor has been remove from a woman's breast, why can't test be run on the tumor to determine exactly which chemotherapy drug will kill the tumor.  I have a very aggressive  (BR score 9), ER negative, progesterone negative, non Her2/neu expressed, tumor.  A lumpectomy was performed and 5cm tumor was removed ( with shallow margins), I then took 4 cycles of Adriamycin and Cytoxan over an 8 week period. The CEA 27-29 tripled between the 4th and 8th week of chemo, I then had a mastectomy and a 4 cm tumor was found in the breast. Again the margins are thin and I'm scheduled for radiation after chemotherapy is completed. I'm now in my 7th of twelve planned weeks of Taxotere coupled with Xeloda and the tumor markers have risen AGAIN while on chemo. Isn't there any way to test the tumors to determine what drugs are effective on the tumor?  Can this be proposed as a topic for research.  

If we can't keep the tumor from growing while on chemo what hope is there for me after treatment. I understand that Tamoxifen probably won’t help me since I'm estrogen receptor negative and 51 years old, but pre-menopausal.

[CCF-RN,MSN-rf]

Dear VJSabb:  There is at least one laboratory in this country that does chemosensitivity testing on tumors.  Its usefulness has not been proven and it is quite controversial for clinical use at this point. Your situation of developing a 4cm tumor during chemotherapy is not typical.

[ritavv]

I remembered this study from 2002:
http://www.cancerpage.com/cancernews/cancernews4172.htm

Test May Help Predict Chemotherapy Response
by Jacqueline Stenson

NEW YORK, Apr 08, 2002  (Reuters Health) - An experimental test may help doctors quickly determine whether a particular regimen of chemotherapy is working, saving crucial time if another treatment approach is warranted, preliminary research suggests.

more at above link.

[surgeon]

bacteria can be tested for antibiotic sensitivity by growing them on a plate of food, and placing various antibiotics on the plate, to see where growth is inhibited. That technique is being tried with cancer cells and chemo agents. The problem is that it's much harder to get cancer cells to grow on a plate of food; and to do so at a rate at which inhibition of growth can be detected in a timely manner. It's one of many goals of cancer researchers. We're not there yet, at least not to the extent that it's available for clinical use.

[VJSabb]

Thanks for your help.  I will discuss the information with my oncologists and hopefully the next set of drugs will do me some good.

[lani.t]

Check out www.rationaltherapeutics.com

I discovered this years ago when I did research on my cancer.  This is not for just everyone, because they won't be able to help you if you contact them post surgery.  They would want to get your tumor right off from the operating table.  But even if you can arrange that, I suggest that you do a thorough research checking references etc. to see if it's reasonable to do it.  I have not used their services so I can't vouch for them.

[gpawelski]

Chemosensitivity Testing

Fresh samples of the patient's tumor from surgery or a biopsy are grown in test tubes and tested with various drugs. Drugs that are most effective in killing the cultured cells are recommended for treatment. Chemosensitivity testing does have predictive value, expecially in predicting what "won't" work. Patients who have been through several chemotherapy regimens and are running out of options might want to consider chemosensitivity testing. It might help you find the best option or save you from fruitless additional treatment.

Lose Dose Chemotherapy

Giving low doses of several drugs every day by mouth. There would be no needles and the side effects are expected to be mild. Unlike standard chemotherapy, which is given in high doses to kill as many cancer cells as possible, the lower-dose regimen is meant to attack the blood vessels that feed the tumor. Tumors create their own supply lines by secreting substances that stimulate the formation of new blood vessels and researchers suspect that frequent low doses of certain drugs may disrupt the growth of those new vessels, starving the tumor.

The treatment includes small daily doses of standard chemotherapy drugs and two other drugs that have been found to inhibit the formation of new blood vessels, called angiogenesis. One is Celebrex and the other is Thalidomide. It is offered only to people who have no other options, who have advanced tumors that standard treatment cannot cure or those for whom standard chemotherapy has quit working.

Women with advanced cancer are being given smaller, more frequent doses of chemotherapy to reduce side effects. It is hoped that low-dose treatment may help other cancer patients, not just those who are considered terminal. It may work just as well or even better, maybe through this ability to cause an anti-angiogenesis effect.

This approach to treatment is based on something that can frequently occur in people, when a tumor becomes resistant to chemotherapy and high doses stop working. It is believed that angiogenesis plays a role. Angiogenesis is essential to the survival of many tumors. Many chemotherapy drugs, in addition to killing tumor cells, also fight angiogenesis. But, if these medicines stop angiogenesis, chemotherapy should work better than it does. Blood vessel cells are less likely than tumor cells to become resistant to chemotherapy, so if cancer cells become drug resistant, these medicines should still be able to shrink tumors by destroying their blood supply.

The reason chemotherapy was not stopping angiogenesis was that chemotherapy is usually given in big doses, with breaks of several weeks between doses to let the body recover. During the breaks, the tumor's blood vessels could grow back. By giving chemotherapy more often, at lower doses, it might prevent the regrowth of blood vessels and kill the tumor or at least slow its growth.

It is especially important to study low-dose therapies now because they are being used increasingly in clinics. Doses, timing and combinations all need to be worked out. Doctors need to find out whether the treatments can make patients live longer and whether tumors will eventually outsmart the drugs and find ways to survive even without angiogenesis.