The information presented in this document summarizes the collective experience of several people whose cancers have been resistant to standard chemotherapy treatment for their particular type of tumor.
Depending on how well the tumor cells live/grow or fail to live/grow, each chemotherapy is rated as sensitive, resistant or intermediate. The concept here is that you are better off using a chemotherapy drug that your tumor reacts to strongly than one your tumor resists.
The practice of cell drug resistance assays is not standard for several reasons. The assay is chiefly useful for suggesting unusual combinations of chemotherapy which may not be among those commonly used for a particular cancer. Simply because of the process of getting the specimen ready to test and the fact that the test is in vitro, some oncologists object to the assay.
Because these tests are in vitro, not in vivo, results may vary when a patient actually receives the chemo. However, from a patient's perspective, if a tumor has not been effectively reduced using several different chemotherapy regimens, anything that increases the likelihood of a tumor's responding is a good thing.
Particularly, if you have already had any biopsies or surgeries, we've found that you need to talk to the laboratory or laboratories you're looking into so that you can get their advice before you pursue the cell drug resistance assay technique further.
I had the tissue sample taken at the time of my modified radical mastectomy and got the results back in about two weeks.
Because the hospital where my surgery took place and most of my doctors did not support the idea of this assay, I was advised by another doctor, who did support doing this test, to make all the arrangements myself. Since the normal hospital surgery procedures did not include doing this kind of test, something might have fallen through the cracks. Everyone may not need to take these precautions.
I contacted the lab I had selected several days before the surgery. The lab, which was local to my area, messengered the vial of transport media to me at home the afternoon before surgery. This particular lab will also air express to distant cities. The package also included full instructions for the surgeon and pathologist I kept it in the refrigerator overnight, then carried it on a baggie of ice to the surgery.
The day before surgery I contacted the head of the Department of Pathology at the hospital where my surgery would take place. He agreed to handle the specimen transfer personally. He arranged for the surgeon to call him a few minutes before the surgery was complete; then he came over himself to make sure everything was handled correctly. After he had the speciman, the Pathology Department's administrative staff called the laboratory that I had selected and the lab sent a messenger to pick up the sample.
I have simplified it here but I actually talked to everyone involved with the surgery, even the residents and medical students that were present for my surgery. Absolutely everyone knew how important this was to me! And, it ended up going well and getting done as planned.
The lab needs one to two grams of tumor material, although the particular laboratory I used said that their tests could effectively use involved lymph nodes as well. I had been concerned about the fact that my particular tumor, which is inflammatory breast cancer, was not a solid tumor mass. I was actually aiming for the lymph nodes to be sent. However my surgeon, who had used these assays before, felt that breast tissue would be desirable since the makeup of the lymph nodes may have been changed from the chemo that I'd already had. Because he told me this as I was being wheeled into the operating room, I did not get the chance to call the laboratory to ask their view on this detail. In the end, a specimen of breast tissue was sent.
The final report has a lot of technical information and indicates that I am sensitive to six of those tested, resistant to one, and intermediately responsive to nine. The two chemos I had already received were in the intermediate category. For my case, the laboratory picked the chemos to test. However, they will test specific chemos at your or your doctors' request.
The greater portion of a textbook on this topic can also be found on the web written by Dr. Larry M. Weisenthal. The entire document begins at Cell Culture Drug Resistance Testing (CCDRT).
Several companies offer commercial testing using this technology. They are listed below.
None of the essays entitled Patients' Perspectives is intended to provide medical, legal, or psycho-social advice. For those kinds of information, you should contact qualified practictioners in your local area. We do intend to convey our members' experiences with the various procedures involved in cancer treatment from the perspective of the patient.