Ask Dr. Block: Do you recommend patients obtain chemo-sensitivity testing of tissue samples?

One of the most critical decisions that cancer doctors help patients make is determining which chemotherapy and molecular regimen is likely to work best.  Often, there are many options with no clear-cut reason to choose one over another. While existing research data may help a doctor select one regimen over another, each patient’s tumor characteristics speaks more directly to their unique biology.

Molecular target therapies and chemotherapies work brilliantly for a few patients, pretty well for some, and poorly or not at all for others. This holds true even for people with the same stage of the same cancer. Every cancer is unique; whether its breast, colon, pancreatic cancer or any other kind of cancer.  Along with a comprehensive and individualized integrative program, the art of our mainstream approach to cancer treatment is to determine which set of chemotherapies or molecular target drugs have the most likely chance of countering malignant growth.  Genomic and proteomic testing provide information on growth pathways and the molecular characteristics of a patient’s disease. At Block Center, we test these routinely, while going further with the results by mapping each patient’s tumor growth pathways in order to tailor a drug and nutraceutical program to inhibit growth.

Additionally, a lesser known method of determining the optimal drug regimen is also available. . Chemotherapy-sensitivity assays (testing) help determine which drugs the patient’s own cancer tissue is most sensitive to.  By exploring and testing drugs with a patient’s tissue in the lab, it becomes easier to determine what the best match of a particular chemotherapy protocol or targeted drug would be before trying it out on the patient.

In 2013, I wrote a foreword for a book authored by Dr. Robert Nagourney (Outliving Cancer, that detailed his groundbreaking work with chemosensitivity testing. Dr. Nagourney has provided me and my patients with an invaluable tool in the task of selecting optimal chemotherapy regimens. Selecting regimens with a greater likelihood of their being effective avoids unnecessary protocols that may not work, or worse, may cause unnecessary adverse side effects. By increasing the possibility of selecting the optimal drug protocol, we can boost the potential for better overall response, remission and survival.

Those of you who know my work will appreciate why I am a supporter of Dr. Nagourney’s work.  His recognition of the importance of the micro-environment is a point of distinction of his testing methodology. A considerable focus of my own work is based on assessing the patient’s micro-environment – their biochemical, metabolic and nutritional terrain – with the use of advanced laboratory testing. With these results in hand, I implement a nutrition and drug intervention plan aimed at creating an inhibitory environment hostile to cancer.

In a similar manner, Dr. Nagourney’s work tests the cancer cell in the context of this micro-environment – where the cancer cells reside. When a tumor sample arrives at Dr. Nagourney’s Rational Therapeutics laboratory, it’s broken up into “micro-spheroids,” fragments that preserve the tumor, along with its surroundings.  Dr Nagourney and his staff then test drugs in a situation closer to real-life biology than most other chemosensitivity tests. Their team will then test numerous chemotherapeutic drugs as well as drug combinations against the patient’s actual tissue sample.

So yes, if clinically appropriate you should have molecular testing performed, a more comprehensive analysis than is the norm. But equally important, don’t miss the clinical opportunity to have your surgeon transport “fresh” tumor tissue for chemosensitivity testing. It may make all the difference in your attaining a successful treatment outcome.