Brother recently diagnosed with Adenocarcinoma - Correct Chemo Test - 1265406

I believe the follow discussion by JimC refers to the type of testing you're asking about. Please let me know if I'm mistaken.

'Don't be too disappointed. Chemosensitivity testing is generally not well-regarded among oncologists. As Dr. West has said:

"I think that this work is very interesting, but companies professing to be able to predict what treatments will work have been promoting these services for well over a decade, yet they are not considered a standard approach yet. Why? Because there are major differences between an isolated collection of tumor cells in the lab and the actual biological condition of the cancer in a living patient, which can be far more heterogeneous, depends on blood supply to the cancer, metabolism of the treatment, and has an ongoing ability to divide and generate new mutations. But most importantly, there is no prospective study of multiple patients that has ever been conducted by a company that offers sensitivity testing that has ever been shown to improve outcomes for patients with lung cancer." - http://cancergrace.org/forums/index.php/topic,1173.msg6153.html#msg6153

And as Dr. Weiss points out:

"An assay that does not work could potentially harm patients. Let's say, for example, that the assay predicts resistance that is not present to what our current studies suggest is the best drug in a given situation. If I then use a different drug, I have harmed my patient. Let's be clear hear--we all have the same goals of improving care. We just have different opinions about how to get there." - http://cancergrace.org/forums/index.php/topic,3082.msg31972.html#msg319… '
from http://cancergrace.org/forums/index.php?topic=9415.0

Best to you and your brother,
Janine

Hi jimmas,

Welcome to GRACE. I'm sorry to hear of your brother's diagnosis, and I hope that we can help you with answers to the many questions you may have.

While these types of assays have not been proven helpful, there are some genetic mutations/alterations for which not only tests exist but also effective treatments to target those mutations. Most notably, EGFR mutations can be treated with inhibitors such as Tarceva (erlotinib) and ALK rearrangements can be treated with Xalkori (crizotinib). Those tests and treatments are part of the standard practice in treating advanced lung cancer, so this is something to discuss with his oncologist.

You may find helpful Dr. Weiss' very thorough "An Introduction to Lung Cancer" which can be found here: http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/ as well as the GRACE FAQ on first-line treatment here: http://cancergrace.org/lung/2010/09/18/lung-faq-ive-just-been-diagnosed…

Please let us know as further questions arise.

JimC
Forum moderator

I agree with Janine and Jim, who have based their responses on many similar conversations we've had here. The concept is intuitively appealing, but there is a huge gap between results of a lab-based test and the real world condition. When you ask about the possible harms, there are recent trials with similar chemosensitivity assays that show a better result for the arm where all of the patients received the same standard therapy than in the arm where patients receive a tailored therapy.

Until there are trials done that show that these tests actually improve outcomes in patients, they are not of value in patient care.

I would underscore that testing for specific mutations such as EGFR and ALK, for which there are specific oral targeted therapies that have great potential benefit, is an established standard of care that clearly does improve clinical outcomes for the patients with one of these "activating mutations".

Good luck with your brother's upcoming treatment.

-Dr. West