Abstract
BackgroundThe use of standard chemotherapy regimens has changed the application of chemosensitivity tests from all chemotherapy-eligible patients to those who have failed standard chemotherapy, which includes patients with highly advanced, relapsed, or chemoresistant tumors.MethodsWe evaluated a total of 43 advanced primary and relapsed gastric cancers for chemosensitivity based on drug dose response curves to improve the objectivity and quality of quantitative measurements. The dose response curves were classified based on seven expected patterns. Instead of a binary chemosensitivity evaluation, we ranked drug sensitivity according to curve shapes and comparison with the peak plasma concentration (ppc) of each drug.ResultsA total of 193 dose response curves were obtained. The overall informative rate was 67.4%, and 85.3% for cases that had a sufficient number of cells. Paclitaxel (PXL)and docetaxel tended to show a higher rank, while cisplatin (CIS) and 5-fluorouracil (5-FU) tended to show resistance, particularly among the 20 cases (46.5%) that had recurrent disease after receiving chemotherapy with CIS and S-1 (5-FU). As such, we speculate that the resistant pattern of the chemosensitivity test suggests that cells with acquired drug resistance were selected by chemotherapy. Indeed, we observed a change in the chemosensitivity pattern of a sample before and after chemotherapy in terms of PXL sensitivity, which was used after primary chemotherapy.ConclusionsThese results suggest that: (i) the dose–response pattern provides objective information for predicting chemosensitivity; and (ii) chemotherapy may select resistant cancer cell populations as a result of the therapy.
Highlights
The use of standard chemotherapy regimens has changed the application of chemosensitivity tests from all chemotherapy-eligible patients to those who have failed standard chemotherapy, which includes patients with highly advanced, relapsed, or chemoresistant tumors
A sufficient number of cells for the watersoluble tetrazolium (WST) assay was obtained in 34/43 (79%) cases, of which 16/22 (72%) cases were from solid tumors and 18/21 (86%) were from ascites
The assay can more accurately determine appropriate drug regimens based on the tumor response to drugs using a currently available and reliable technique with a sufficient number of tumor cells
Summary
The use of standard chemotherapy regimens has changed the application of chemosensitivity tests from all chemotherapy-eligible patients to those who have failed standard chemotherapy, which includes patients with highly advanced, relapsed, or chemoresistant tumors. Standard chemotherapy for gastric cancer is considered to have a significant treatment effect as evaluated by disease free survival (DFS) and overall survival (OS) [1,2,3]. Postoperative chemoradiotherapy for gastric cancer was conducted in the United States with DFS and three-year OS rates of 48% and 50%, respectively [4]. Despite the implementation of standard adjuvant chemotherapy, the recurrence rate remains 30% to 40% within five years of therapy [2,5,6,7]. Highly advanced chemo-naive primary cancers as well as relapsed tumors after adjuvant chemotherapy are major subjects for chemosensitivity tests
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