May 2009 ChemoFx® offers hope to cancer patients
By Allen Costantini, KARE 11 News
(Copyright 2009 by KARE. All Rights Reserved.)

Ann Jones, 55, of Saint Paul can watch the unstoppable movement of the Mississippi River from her downtown balcony. The long-time nurse now says she is watching a journey of her own, "A journey of the unexpected." Her unwelcome companion on that journey was an ovarian cancer tumor. Jones stares across the mighty river at Harriet Island and sighs, "My tumor was an unusual one, which they had trouble figuring out what it was at first."

Thus began a struggle as challenging as the teams of rowers pulling hard against the current below her windows. The tumor was removed by Gynecological Oncologist/Surgeon Matthew Boente, M.D. of Edina-based Minnesota Oncology. The biopsy of the tissue indicated that statistically Jones had only a 50-50 chance of surviving 2 years. The memory of that moment moistens her eyes. "My family was reading that over Christmas. So, it gave everyone a bit of pause. How many more Christmases are we gonna have?"

Dr. Boente told Jones and her husband, Jeff, that choosing a treatment for her cancer posed problems. His first inclination was to resort to standard treatments. "I mean, Platin's kind of been, you know, the hallmark of treating gynecologic cancers for three or four decades."

However, Dr. Boente says there was something different about this patient and her cancer. "In Ann's case, it would have been, it would have been hard to choose because she had such a rare cancer that there were only 30 or 40 reported in the literature in the last 30 or 40 years." He described her tumor as "dissolving her pelvis." He called the surgery "a good operation, and then, we got the curve ball with the type of cancer it was."

Dr. Boente took a course of action that he admits many in his field would consider "controversial." He turned to Precision Therapeutics of Pittsburgh for a "Sensitivity Assay." A sample of Jones' tumor cells was sent to the Pennsylvania laboratory. Scientists at Precision Therapeutics tested the cells with a number of cancer-fighting drugs. The report from Pittsburgh was, in essence, a personal drug profile for Ann Jones' specific cancer.

The "Assay" guidance is an approach Dr. Boente says he has used in dozens of cases. "They're not only pretty good at telling you which drugs will work, but they're really, really good at telling which drugs won't work. If they tell you not to use one, in other words, if the Assay predicts resistance, will that save the patient a lot of misery? 'Because usually you take tow or three cycles (of drugs) to figure that out clinically."

His success rate with assay-guided treatment? "I would say that, on average, you know, all comers, it's somewhere in the 60% range." That rate is twice the 30% average national success rate for ovarian cancer. However, those figures are for "recurrent" ovarian cancers, meaning cancers in patients who had been in remission, then suffered a re-occurrence of the disease. Ann Jones is a first-time cancer patient. Dr. Boente calls this situation "upfront," rather than "recurrent." He is satisfied with the assay-guided approach for recurrent ovarian cancer and for Ann Jones' case, but he is not ready to pronounce it as best for everyone. "In other words, there's a standard group of drugs that we use as front line therapy and there's not enough data really yet to suggest that those drugs should be replaced by what this assay shows."

The treatment style may remain controversial in Jones' case, but perfecting an accurate method of tailoring cancer treatments is one of medicine's Holy Grails. In a medical tower at the University of Minnesota's Twin Cities campus, researcher Brian Van Ness, Ph.D guides a team at the U's Masonic Cancer Center. He agrees with the concept espoused by assay-guided treatments. "I think targeting drugs to specific cancers is a very good idea. It's all about personalizing medicine."

At first glance, Van Ness's team seems to mimic the work of Precision Therapeutics. The lab holds sterile hood workspaces and an array of Petri dishes. Van Ness explains, "The test system that we're looking at right now is we're isolating the tumor cells and growing them in this culture and then testing them for drug sensitivity."

However, Van Ness thinks the answer goes deeper than drug testing. He insists that how a drug works in a lab setting may be very different than how it works in a patient's body, where it is metabolized by the liver and transported through the bloodstream. "I think what you see in the laboratory might be a good indicator but it may not be the final answer on how a person responds to the drug when you add all of the complexities of the body to that."

Dr. Boente agrees that critics of lab testing alone as cancer's ultimate nemesis may have a point. "The big complaint, or nay-sayers, will say, well, you know, what happens in a plate may not happen in the human body and you have to take into account the immune system and a person's immune system has a lot to do with how well they respond to cancer treatments. So, it's not always just the drugs. It's how well their immune system fights the cancer, too. It's kind of a combination of both. Also, it's helpful if a person has a good heart, good lungs, good kidneys. Kidneys are very important, so, if doesn't really matter what the assay tells you, if they tell you to use a drug that's going to be renal secreted and the person doesn't have very good kidney function, it doesn't really help you."

Dr. Van Ness's research is called Pharmacogenomics, studying a patient's needs by going down to the level of his/her genes and then using that information to predict how that patient's body will respond to various cancer treatments. "So, our genetic predictors are making an attempt to personalize the medicine."

The two approaches dove-tail. In Ann Jones' case, the personal touch, courtesy of Dr. Boente and the Precision Therapeutics Chemo Sensitivity Assay, seems to be exactly what she needed. Dr. Boente is pleased. "In that particular case, I did use it as upfront therapy and looks like we hit the homerun. It's working real nice."

Ann Jones completes her sixth and last round of Chemotherapy this month. She says she will be very glad to be finished with the tiring hours of waiting for the drugs to enter her system. She has praise for the patient staff who attend to her care under Jeff's watchful eyes. She knitted caps to wear last winter when the chemo treatments claimed her hair. One of her creations is composed of teal-color yarn, the color of ovarian cancer. The caps are as individualized as her treatment.

The new world of drug sensitivity assays and pharmacogenomic research promises a very personal approach to cancer medicine. Ann Jones watches the Mississippi splash over a trapped piece of driftwood below her balcony and sees a methaphor with her own struggle since December. "It's still your own journey, no matter who you are."

About Precision Therapeutics
Precision Therapeutics is an oncology services company dedicated to the individualization of cancer therapy. Precision Therapeutics is a leader in the development and delivery of treatment support tools that assist physicians and benefit cancer patients. For more information visit www.precisiontherapeutics.com, call 800-547-6165 or email info@ptilabs.com