Open Access Research

Correlation of pretreatment drug induced apoptosis in ovarian cancer cells with patient survival and clinical response

Emery Salom110*, Manuel Penalver1, Howard Homesley23, Matthew Burrell4, Audrey Garrett5, Cary A Presant8, James Rutledge6, Michael Chernick7, Allan Hallquist9 and Mathieu Perree9

Author Affiliations

1 South Florida Gynecologic Oncology, Coral Gables, FL, USA

2 East Carolina University Brody School of Medicine, Greenville, NC, USA

3 Wake Forest University School of Medicine, Winston-Salem, NC, USA

4 Northside Hospital of Atlanta, Atlanta, GA, USA

5 Sacred Heart Medical Center, Eugene, OR, USA

6 Data Vision, Dayton, OH, USA

7 The Lankenau Institute of Medical Research, Wynnewood, PA, USA

8 Wilshire Oncology Medical Group – US Oncology, Los Angeles, CA, USA

9 DiaTech Oncology, Montreal, Canada

10 Palmetto General Hospital, 2001 W. 68th St, Hialeah, FL 33016, USA

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Journal of Translational Medicine 2012, 10:162  doi:10.1186/1479-5876-10-162

Published: 8 August 2012

Abstract

Background

This study was performed to determine if a chemotherapy-induced apoptosis assay (MiCK) could predict the best therapy for patients with ovarian cancer.

Methods

A prospective, multi-institutional and blinded trial of the assay was conducted in 104 evaluable ovarian cancer patients treated with chemotherapy. The MiCK assay was performed prior to therapy, but treating physicians were not told of the results and selected treatment only on clinical criteria. Outcomes (response, time to relapse, and survival) were compared to the drug-induced apoptosis observed in the assay.

Results

Overall survival in primary therapy, chemotherapy naïve patients with Stage III or IV disease was longer if patients received a chemotherapy which was best in the MiCK assay, compared to shorter survival in patients who received a chemotherapy that was not the best. (p < 0.01, hazard ratio HR 0.23). Multivariate model risk ratio showed use of the best chemotherapy in the MiCK assay was the strongest predictor of overall survival (p < 0.01) in stage III or IV patients. Standard therapy with carboplatin plus paclitaxel (C + P) was not the best chemotherapy in the MiCK assay in 44% of patients. If patients received C + P and it was the best chemotherapy in the MiCK assay, they had longer survival than those patients receiving C + P when it was not the best chemotherapy in the assay (p = 0.03). Relapse-free interval in primary therapy patients was longer if patients received the best chemotherapy from the MiCK assay (p = 0.03, HR 0.52). Response rates (CR + PR) were higher if physicians used an active chemotherapy based on the MiCK assay (p = 0.03).

Conclusion

The MiCK assay can predict the chemotherapy associated with better outcomes in ovarian cancer patients. This study quantifies outcome benefits on which a prospective randomized trial can be developed.