In vitro chemotherapy testing of gynecologic tumors: basis for planning therapy?

The human tumor stem cell assay (HTSCA) has broad research applications in the field of cell biology as well as in clinical chemotherapy. This report examines the applicability of the HTSCA to patient treatment planning, asking: (1) How often will gynecologic tumors grow in the assay? (2) What kinds of therapeutically useful information can be gained from the assay? (3) What are the correlations between in vitro results and patient treatment responses? Tumor specimens from 207 patients having ovarian, cervical, or endometrial carcinomas have been studied with the HTSCA, 183 of which have grown in vitro. Of 103 ovarian cancer specimens which grew in culture, 564 separate drug assays have been done, looking for patterns of sensitivity among "first line" drugs as well as drugs used for relapsing patients. More than half of the patients studied had one or more drugs which showed in vitro activity. Nineteen patients have had single-agent chemotherapy prospectively selected on the basis of the HTSCA results with a "sensitive" predictive accuracy of 90% and a "resistant" predictive accuracy of 100%.