Frequently Asked Questions
Patients are typically treated with drugs demonstrated to be effective from studies of the general population. Should the first treatment not work, oncologists would move on to the next best option. This trial-and-error approach means that while a patient’s particular cancer may be unique, their therapy is likely to be very standard. However, Invitrocue’s advances in three-dimensional organoid technology have led to the development of the Onco-PDO® (Patient-Derived Organoids) test that allows physicians to more effectively individualize treatment.
The Onco-PDO® test is a chemosensitivity and chemoresistance test that offers a more targeted and personalized approach to cancer treatment by creating a clinically-relevant predictive in vitro model that quantifies tumour response to standard-of-care chemotherapeutics. The information provided by this test assists physicians in developing a more informed and individually tailored treatment strategy for a patient’s cancer#.
# Response data in the in vitro Onco-PDO test may not always be reflective of patient-specific response, due to additional physiological factors.
A chemosensitivity assay is a laboratory test that determines how effective specific chemotherapeutic agents are in killing (cytotoxic) or inhibiting (cytostatic) the proliferation of an individual patient’s cancer cells (positive predictive accuracy). A chemoresistance assay is a laboratory test that identifies potentially ineffective chemotherapeutic agents that do not influence in vitro tumour cell growth or viability (negative predictive accuracy). Onco-PDO® is both a chemosensitivity and chemoresistance assay that determines the sensitivity and resistance of cancer cells to individual chemotherapeutic agents. Depending on how well the tumour cells respond to each chemotherapeutic agent, they are rated on a sensitivity scale, from resistant to sensitive.
A portion of a patient’s solid tumour – 2-3 core biopsies – is mechanically/enzymatically disaggregated and established in primary culture within multi-well plates. Cultures are verified as cancer cells, and then exposed to selected chemotherapeutic agents (at Cmax). Cmax is the maximum serum concentration that a drug achieves in the body after the drug has been administrated, based on published literature. The number of viable cells remaining post-treatment is determined based on quantification of the live cell proteases present, which signals the presence of metabolically-active cells. The amount of live cell proteases is directly proportional to the number of viable cells present in culture. The resultant fluorescence readouts in treated wells are then compared with those in untreated control wells to generate response data for each chemotherapeutic agent tested on a given patient specimen. The response data is then used to anticipate whether a patient will be responsive or resistant to a therapeutic agent, and assist the oncologist in making treatment decisions.
This test provides three key clinical advantages:
• Fast Turnaround: The test report is delivered within 3 weeks to ensure continuity of clinical care without delaying treatment.
• Comprehensive: The test can include all standard-of-care chemotherapeutics to ensure the most comprehensive look at the patient’s potential treatment options.
• Actionable: The test report helps clearly inform treatment decisions by identifying relevant and actionable findings based upon the response of the patient’s cancer cells to chemotherapeutics in the laboratory^.
^ The Onco-PDO® Testing Service is not a substitute for visits to a physician. The information in these reports should not be used alone to determine or adjust any treatment plan. Many factors besides the information covered in these reports can influence how a patient responds to a drug.
Next-Generation Sequencing (NGS) analyses cancer specimens for genomic alterations known to be relevant in cancer. The test results can only be used to suggest targeted therapies that are available or associated with the identified genomic alterations, based on published studies of the general population. By comparison, Onco-PDO® is a clinically-relevant, real-time modelling and in vitro testing service that can predict individual patient tumour response to standard-of-care chemotherapies, including target-defined therapeutic agents, by using the individual patient’s own tumour cells.
The test is for patients who need chemotherapy, and most useful for patients with advanced cancers or relapsed patients who have not responded well to first line therapy. First line therapies are usually subject to strict regulatory guidelines, and oncologists do not have much leeway to choose drugs other than standard-of-care drugs for their patients. For relapse patients, oncologists have a wider choice of drugs, and time for the patient is more limited as the body cannot afford to undergo any unnecessary rounds of chemotherapy, making every data point that could aid clinical decision making valuable. Our hope is that one day the Onco-PDO® test will become a standard-of-care test that can screen drugs for first line therapy as well.
Currently, we are focused on doing Onco-PDO® tests for breast, colorectal and head and neck cancer. We are working on expanding our testing indications to ovarian, lung, prostate and pancreatic cancers as well.
The test report will provide the following information:
• An overview of how the patient’s cancer cells have responded to the panel of standard-of-care chemotherapeutics in the laboratory
• An indication of the patient’s likelihood of being sensitive to a drug and/or how well or poorly their tumours will respond to a drug
• Prioritised therapeutic options according to the chemosensitivity of the cultured tumour cells
Each individual report is specially designed to clarify the results for the ordering physician and aid in their treatment decision making.
Once your patient’s sample is received for testing, results should be available in 2-3 weeks*.
* There is no guarantee that a tumour model can be successfully developed from the patient sample taken to complete the test, due to potential sample contamination, low cell number / viability or other limitations with the sample collected. The varying degree of success ranges from 30-70% depending on the cancer type, size and quality of the sample collected.
We require fresh tumour tissue from surgery or biopsy, which are needed to be transported in chilled transport media to the laboratory within 24 hours. Formalin-fixed paraffin-embedded tumour tissue cannot be used.
Either a minimum of 1cm3 of tumour tissue or 2-3 core needle biopsies are required. Anything less may risk the test failing to achieve completion.
The test is performed in our laboratory in Singapore with the highest standards of laboratory practice. Tests for patients in Europe are performed in our laboratory in Munich, Germany.