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Chemotherapy sensitivity/resistance testing not ready for prime time

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – No chemotherapy sensitivity and resistance assays have sufficient supporting evidence to justify their use in oncology practice. That’s the conclusion of an American Society of Clinical Oncology (ASCO) panel, reporting in the Journal of Clinical Oncology online July 25.

“The use of CSRAs (chemotherapy sensitivity and resistance assays) to select chemotherapeutic agents for individual patients is not recommended outside of the clinical trial setting,” advises the ASCO Update Working Group, charged with revising the ASCO guidelines on CSRAs published in 2004.

Their 2011 conclusion is actually the same as the 2004 recommendation.

The panelists, headed by Dr. Harold J. Burstein with the Dana-Farber Cancer Institute in Boston, Massachusetts, explain that CSRAs are in vitro analyses of sample cancer cells intended to predict a tumor’s particular chemotherapy sensitivity or resistance in order to enhance patient selection for a specific treatment.

For their update, the group identified 11,313 new articles on the topic. This yielded a short list of 1298 articles for abstract review, which in turn produced only 21 articles that met predefined criteria for consideration.

Data were extracted for four types of assays: adenosine triphosphate bioluminescence (ATP), extreme drug resistance assay (EDRA), methyl-thiazolyl-diphenyltetrazolium bromide (MTT), and the ChemoFX test (by Precision Therapeutics, Pittsburgh, Pennsylvania).

The Update Committee generally found the data for these assays unconvincing, and concluded that no changes to the 2004 guidelines were warranted.

Instead, they recommend, “Oncologists should make chemotherapy treatment recommendations based on published reports of clinical trials and a patient’s health status and treatment preferences.”

However, they add, “Because the in vitro analytic strategy has potential importance, participation in clinical trials evaluating these technologies remains a priority.”

Reference:
American Society of Clinical Oncology Clinical Practice Guideline Update on the Use of Chemotherapy Sensitivity and Resistance Assays
J Clin Oncol 2011;29.