Functional Profiling to Select Chemotherapy in Untreated, Advanced or Metastatic Non-small Cell Lung Cancer

Background/Aim: To assess the impact of drug selection upon the treatment of advanced and metastatic non- small cell lung cancer (NSCLC), we applied a functional platform that measures drug-induced cell death in human tumor primary-culture micro-spheroids isolated from surgical specimens. Patients and Methods: At diagnosis, microspheroids isolated by mechanical and enzymatic disaggregation were examined for drug-induced cell-death by morphology and staining characteristics. Drugs were administered using standard protocols. Thirty-one patients, who received at least one cycle of therapy, were evaluable. All patients signed informed consent. Results: Twenty out of 31 patients responded (64.5%), 1 completely and 19 partially, providing a two-fold improvement over historical control of 30% (p=0.00015), a median time-to-progression of 8.5 months and a median overall survival of 21.3 months. Conclusion: This functional platform is feasible and provides a favorable objective response rate, time-to-progression and survival in advanced, metastatic, untreated NSCLC, and warrants further evaluation. Bronchogenic carcinoma is the leading cause of cancer- related death in the US with 160,340 estimated deaths in 2012. The majority of patients present with non-small cell lung cancer. While the 1-year survival for advanced lung cancer has improved from 35% to 42% over the past 3 decades (1), the 5-year survival for stage III & IV disease