Stebbing Justin, Paz Keren, Schwartz Gary K, Wexler Leonard H, Maki Robert, Pollock Raphael E, Morris Ronnie, Cohen Richard, Shankar Arjun, Blackman Glen, Harding Victoria, Vasquez David, Krell Jonathan, Zacharoulis Stergios, Ciznadija Daniel, Katz Amanda, Sidransky David
Department of Oncology, Imperial College and Imperial Healthcare National Health Service Trust, Hammersmith Hospital, London, United Kingdom.
Cancer. 2014 Jul 1;120(13):2006-15. doi: 10.1002/cncr.28696. Epub 2014 Apr 4.
Patients with advanced, metastatic sarcoma have a poor prognosis, and the overall benefit from the few standard-of-care therapeutics available is small. The rarity of this tumor, combined with the wide range of subtypes, leads to difficulties in conducting clinical trials. The authors previously reported the outcome of patients with a variety of common solid tumors who received treatment with drug regimens that were first tested in patient-derived xenografts using a proprietary method ("TumorGrafts").
Tumors resected from 29 patients with sarcoma were implanted into immunodeficient mice to identify drug targets and drugs for clinical use. The results of drug sensitivity testing in the TumorGrafts were used to personalize cancer treatment.
Of 29 implanted tumors, 22 (76%) successfully engrafted, permitting the identification of treatment regimens for these patients. Although 6 patients died before the completion of TumorGraft testing, a correlation between TumorGraft results and clinical outcome was observed in 13 of 16 (81%) of the remaining individuals. No patients progressed during the TumorGraft-predicted therapy.
The current data support the use of the personalized TumorGraft model as an investigational platform for therapeutic decision-making that can guide treatment for rare tumors such as sarcomas. A randomized phase 3 trial versus physician's choice is warranted.
晚期转移性肉瘤患者预后较差,现有的几种标准治疗方法的总体获益较小。这种肿瘤的罕见性,加上亚型种类繁多,导致开展临床试验存在困难。作者此前报告了多种常见实体瘤患者接受药物治疗方案的结果,这些方案最初是使用一种专有方法(“肿瘤移植”)在患者来源的异种移植模型中进行测试的。
将29例肉瘤患者切除的肿瘤植入免疫缺陷小鼠体内,以确定临床使用的药物靶点和药物。肿瘤移植模型中的药物敏感性测试结果用于个性化癌症治疗。
29个植入的肿瘤中,22个(76%)成功移植,从而能够为这些患者确定治疗方案。虽然6例患者在肿瘤移植测试完成前死亡,但在其余16例患者中的13例(81%)观察到肿瘤移植结果与临床结局之间存在相关性。在肿瘤移植预测的治疗期间,没有患者病情进展。
目前的数据支持将个性化肿瘤移植模型作为一个用于治疗决策的研究平台,该平台可指导肉瘤等罕见肿瘤的治疗。有必要开展一项与医生选择治疗方案进行对比的随机3期试验。