Von Hoff D D
Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78284-7884.
J Natl Cancer Inst. 1990 Jan 17;82(2):96-101. doi: 10.1093/jnci/82.2.96.
It is difficult for anyone to determine why oncologists have not paid more attention to the use of in vitro predictive tests in the care of their patients. A review of already completed in vitro-in vivo correlative trials in 2,300 patients indicates percentages of 69 for true positives and 91 for true negatives from predictive assays. These percentages are as good as or better than those seen with already accepted tests, such as estrogen receptor assays or bacterial sensitivity testing systems. Results of a randomized trial of single-agent chemotherapy selections based on a capillary cloning assay versus a clinician's choice indicate the response rate is significantly higher when single-agent chemotherapy is selected by the cloning assay than when it is selected by a clinician (21% vs. 3%). An ongoing randomized trial in which investigators are attempting to corroborate these results in patients with previously untreated small cell lung cancer has been so slow to accrue patients that it is unlikely these trials and others will ever be completed. The usefulness, if any, of these assays and their potential to provide answers to important questions will never be determined unless attitudes are changed about participation in trials. A tool with potential for helping oncologists select patient therapy could be lost unless participation in these trials is obtained.
很难确定肿瘤学家为何没有更加重视在患者治疗中使用体外预测性检测。对2300名患者已完成的体外-体内相关性试验的回顾表明，预测性检测的真阳性率为69%，真阴性率为91%。这些百分比与已被接受的检测（如雌激素受体检测或细菌敏感性检测系统）的百分比一样好或更好。一项基于毛细管克隆检测与临床医生选择的单药化疗选择随机试验结果表明，通过克隆检测选择单药化疗时的缓解率显著高于临床医生选择时的缓解率（21%对3%）。一项正在进行的随机试验中，研究人员试图在先前未接受治疗的小细胞肺癌患者中证实这些结果，但患者招募速度非常缓慢，以至于这些试验及其他试验不太可能完成。除非改变对参与试验的态度，否则这些检测的有用性（如果有的话）及其为重要问题提供答案的潜力将永远无法确定。除非获得对这些试验参与，否则一种有可能帮助肿瘤学家选择患者治疗方案的工具可能会失去。
