Pretest­ing Cer­vi­cal Tu­mors Pre­dicts Re­sponse To Treat­ment

Wellness Update - - Con­tents -

ST. LOUIS, Mo. – Doc­tors at Wash­ing­ton Uni­ver­sity School of Medicine in St. Louis have shown test­ing cer­vi­cal tu­mors be­fore treat­ment for vul­ner­a­bil­ity to chemo­ther­apy pre­dicts whether pa­tients will do well or poorly with stan­dard treat­ment. The study sup­ports the fu­ture pos­si­bil­ity of per­son­al­ized medicine for cer­vi­cal can­cer, a tu­mor nor­mally ad­dressed with a one-size-fits-all ap­proach. “Even though this is a small study, its strength is that it links a lab test of the tu­mor’s chemo­ther­apy re­sponse to sur­vival out­comes for the pa­tients,” said Julie K. Sch­warz, MD, PhD, as­sis­tant pro­fes­sor of ra­di­a­tion on­col­ogy. “Very few can­cers have been stud­ied this way, and this is the first such re­port for cer­vi­cal can­cer.” Since 1999, nearly all cer­vi­cal can­cer cases have been treated the same way: daily ra­di­a­tion ther­apy tar­geted to the tu­mor plus a weekly in­tra­venous in­fu­sion of the chemo­ther­apy drug cis­platin. “We be­lieve ra­di­a­tion does the ma­jor­ity of the work with cer­vi­cal can­cer,” said Sch­warz. “But a ran­dom­ized trial pub­lished in 1999 showed com­bin­ing it with cis­platin chemo­ther­apy im­proved sur­vival out­comes.” Even to­day, ac­cord­ing to Sch­warz, doc­tors have no way of know­ing who will do well or poorly with the com­bined ra­di­a­tion and chemo­ther­apy ev­ery pa­tient re­ceives. Now, Sch­warz and her col­leagues have shown the tu­mor’s re­sponse to chemo­ther­apy, in­de­pen­dent of ra­di­a­tion, may be a ma­jor de­cid­ing fac­tor in whether a pa­tient will do well with the stan­dard treat­ment. “This is ev­i­dence that cis­platin is not just help­ing the ra­di­a­tion work bet­ter,” Sch­warz said. “It is hav­ing some di­rect toxic ef­fect on can­cer cells that may be hid­ing else­where in the body, some place where the ra­di­a­tion is not hit­ting it, since we tar­get the ra­di­a­tion so pre­cisely to the main tu­mor. We think it would be ben­e­fi­cial for that drug to be se­lected ap­pro­pri­ately for the pa­tient’s in­di­vid­ual tu­mor.” Cer­vi­cal can­cers can be di­vided into two main types based on how they look un­der a mi­cro­scope – squa­mous cell car­ci­noma and ade­no­car­ci­noma. The non­re­spon­sive num­ber was even worse for pa­tients di­ag­nosed with the more com­mon squa­mous cell car­ci­noma, with 46 per­cent dis­ease-free sur­vival at two years.

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