Anna Karenina principle in personalized treatment of bladder cancer according to oncogram: which drug for which patient?

Aim: To evaluate the ex vivo efficacy of chemotherapy, immunotherapy and targeted agents with the oncogram method in patients with bladder cancer and determine the most appropriate personalized treatment agent using immune markers. 

Materials & methods: Bladder cancer tissues were obtained from each patient. After cultivation, cell cultures were divided into 12 groups for each patient and 11 drugs were administered. Cell viability and immunohistochemistry expression were examined. 

Results: A good response rate was determined to be a 23% viability drop. The nivolumab good response rate was slightly better in PD-L1-positive patients and the ipilimumab good response rate was slightly better in tumoral CTLA-4-positive cases. Interestingly, the cetuximab response was worse in EGFR-positive cases. 

Conclusion: Although good responses of drug groups after their ex vivo application by using oncogram were found to be higher than control group, this outcome differed on a per patient basis.

 

Comments:

The aim of the study was to evaluate the ex vivo efficacy of chemotherapy, immunotherapy, and targeted agents in patients with bladder cancer using the oncogram method. The researchers obtained bladder cancer tissues from each patient and cultivated cell cultures. These cell cultures were then divided into 12 groups for each patient, and 11 different drugs were administered. The researchers examined cell viability and immunohistochemistry expression to evaluate the response of the cells to the drugs.

The results of the study showed that a good response rate, defined as a 23% drop in cell viability, was observed in the drug-treated groups compared to the control group. The study also looked at the relationship between specific immune markers and the response to certain drugs. It was found that the good response rate to nivolumab, an immunotherapy drug, was slightly better in patients who were PD-L1 positive. Similarly, the good response rate to ipilimumab, another immunotherapy drug, was slightly better in patients who had tumoral CTLA-4 positivity. On the other hand, the response to cetuximab, a targeted agent, was found to be worse in patients who were EGFR positive.

In conclusion, the study demonstrated that the ex vivo application of the drug groups using the oncogram method resulted in higher good response rates compared to the control group. However, the response to treatment varied on a per-patient basis. The study also highlighted the potential usefulness of immune markers, such as PD-L1, CTLA-4, and EGFR, in predicting response to specific treatments in bladder cancer patients. Further research and validation are needed to establish the clinical utility of these findings and to guide personalized treatment decisions for bladder cancer patients.

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