Getting the Most out of Cancer Treatments

Powerful Patient, 2012

Joyce Graff, host, on powerfulpatient.org

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Dr. Robert Nagourney

Robert Nagourney, MD, Clarifies 10 Points Regarding Chemosensitivity Testing in Cancer Therapy: What It Is and What It Isn’t.

Dr. Nagourney has devised a method of using the patient's own tumor to test a wide range of drugs -- both old and new -- to determine in the lab which of these drugs is likely to be the most effective. The patient can then begin taking this carefully chosen drug.

Joyce reminds people facing cancer therapy that before you begin taking any drug or signing up for any surgery for cancer, you need to seek out the very best knowledge about your particular cancer. Some of the best therapies require a piece of your tumor, and it will be extremely important to collect and preserve the tumor in the right way in order to optimize your chances.

Robert Nagourney, MD, medical director of Rational Therapeutics (www.rational-t.com) in Long Beach, CA, has led in the development of “functional profiling” in human tumors. Using human tumor microspheroids isolated directly from surgical specimens, this platform known as the Ex Vivo Analysis of Programmed Cell Death (EVA-PCD®) measures drug-induced programmed cell death. The EVA-PCD® has been shown to be a robust method for the prediction of clinical response to therapy.  He addresses this type of chemosensitivity testing in cancer therapy – what it is and what it is not.

According to Dr. Nagourney, “Some cancer patients develop a process of collateral sensitivity, whereby resistance to one class of drugs (platins, for example) can enhance the efficacy of other class of drugs (such as, antimetabolite).  Furthermore, patients may be treated with one drug that fails to shrink the tumor, then be treated with several other classes of agents, only then a year or two later, manifest sensitivity to the original drug.”  He added that there is confusion among both physicians and patients about chemosensitivity testing for which he provides the following overview.

In the interview, Joyce works with Dr. Nagourney to translate the following scientific statements into language that patients can understand. As with all living beings there is a "life cycle" of birth, growth, and death, that all cells are supposed to go through. Cancer cells have a way of evading their normal "programmed death" and continuing to live and reproduce.

1. Cancer patients are highly individual in their response to chemotherapies. This is why each patient must be tested to select the most effective drug regimen.
   
   
2. Today we realize that cancer doesn’t grow too much it dies too little. This is why older growth-based assays didn’t work and why cell-death-based assays do.
   
   
3. Cancer must be tested in their native state with the stromal, vascular and inflammatory elements intact. This is why we use microspheroids isolated directly from patients and do not grow or subculture our specimens.
   
   
4. Predictions of response are not based on arbitrary drug concentrations but instead reflect the careful calibration of in vitro findings (in the lab) against patient outcomes – the all-important clinical database.
   
   
5. We do not conduct drug resistance assays. We conduct drug sensitivity assays. These drug sensitivity assays have been shown statistically significantly to correlate with response, time to progression and survival. In other words, the more sensitive the tumor is to a particular drug, the better it is likely that this cancer in this person will shrink and die.
   
   
6. We do not conduct genomic analyses for there are no genomic platforms available today that are capable of reproducing the complexity, cross-talk, redundancy or promiscuity of human tumor biology.
   
   
7. Tumors manifest plasticity (a series of changes) that requires iterative studies. Large biopsies and sometimes multiple biopsies must be done to construct effective treatment programs.
   
   
8. With chemotherapy, very often more is not better.
   
   
9. New drugs are not always better drugs.
   
   
10. Cancer drugs do not know what diseases they were invented for.

“While we could continue to enumerate the principles that guide our practice, one of the more important principles is humility,” says Dr. Nagourney.  “Medicine is a humbling experience and cancer medicine even more so.  Patients often know more than their doctors give them credit for. Failing to incorporate a patient’s input, experience and wishes into the treatment programs that we design, limits our capacity to provide them the best outcome.”

Dr. Nagourney recently was a featured speaker at TEDx where the subject of his talk was “The Future of Cancer Research Lies Behind Us.” View the speech here http://bit.ly/AtfK7m. More information about Dr. Nagourney and Rational Therapeutics is available at www.rational-t.com, on www.facebook.com/rationaltherapeutics and on twitter @RobertNagourney.