Blood test shows effectiveness of chemotherapy

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Chemotherapy saves the lives of millions of cancer sufferers. However, not every treatment works equally well for every patient. With a new test procedure, it would be possible to check right from the start whether and how well the treatment is helping. This could save the patient from a stressful but ultimately ineffective therapy or switch to a more effective one.

Chemotherapy is usually very aggressive and stressful for cancer patients. In addition to acute complaints such as nausea, hair loss and general weakness, they can also permanently damage the body. For example, the heart can be damaged or the active ingredients can even cause other cancers.

Unclear effectiveness

It would therefore be a decisive advantage to know at an early stage whether a therapy will actually help the patient. It is true that we know which type of tumor basically responds to which active ingredient. However, it can react very well to treatment in one patient, while in others it is almost resistant to the same active ingredients. This is especially true when a tumor returns and a second or third chemotherapy is necessary.

At the moment, however, the success of a treatment only becomes apparent after weeks or months - namely when X-rays or CT images reveal whether a tumor has shrunk or not. If the cancer is surgically removed, the main effect of the therapy is that the cancer does not form again there and that no metastases develop.

Certainty after just 14 days

Researchers led by Bee Luan Khoo from the Singapore-MIT Alliance for Research and Technology Center have now developed a method with which the success of the therapy could be predicted much earlier - namely within 14 days. For this purpose, the blood of the cancer patient is examined, more precisely, the cancer cells swimming in it. They have detached themselves from the tumor and move with the bloodstream through the whole body. In the worst case, you will find access to another organ or tissue somewhere, settle in and multiply into a daughter tumor, the so-called metastasis.

The researchers examined a total of 24 blood samples from patients with early breast cancer. To do this, they removed the red blood cells and the plasma, leaving only leukocytes and tumor cells. These are still very rare at such an early stage of cancer: there are one to ten cancer cells for every milliliter of blood.

But this amount was sufficient to investigate the cancer's aggression potential: If they multiplied and clustered together into larger groups, the researchers found that this was an indication of a high risk of metastasis.

Effective or not?

The scientists provided the cancer cells with ideal conditions: plastic microplates (multiwell plates) fitted with tiny pans and provided with a nutrient layer. The cancer cells accumulated and multiplied in the wells - or they did not. If they did well, the researchers treated them with chemotherapeutic agents in different concentrations after three and eleven days - comparable to the drug densities to which cancer cells can be exposed during chemotherapy in the human body.

If the cells died during the treatment or if they no longer formed larger units, the therapy was apparently working. If they continued to grow, the cells were resistant to the poison. Or the dose was not high enough for the researchers to be able to determine the optimal effective dose.

Long-term forecast possible?

Now the procedure is to be reviewed and refined over a longer period of time and with many more patients. At the same time, the scientists want to continue to monitor the health development of their test subjects. They want to check whether their method is actually suitable for providing reliable long-term prognoses about the course of therapy and the survival chances of cancer patients.

Source: Bee Luan Khoo et al .: Liquid biopsy and therapeutic response: Circulating tumor cell cultures for evaluation of anticancer treatment, Science Advances 2016 Jul; 2: e1600274

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