Functional profiling is a laboratory technique that measures how cancer cells respond when they are exposed to drugs and drug combinations.
Put simply, it is a real-time measure of which drugs cause your cancer cells to die, through a process called programmed cell death. By using this approach, we try to determine in the laboratory the best drugs for each patient before they receive them.
Each cancer patient is unique and their response to therapy is very different from one person to the next.
Drugs that work for one patient may not work for another, even if they carry exactly the same diagnosis. This is why each patient should be tested to select the most effective and least toxic drug regimen for them PRIOR to initiating treatment.
When patients are treated without testing, the treating physicians must rely on general guidelines and protocols that cannot capture each patient's unique features. Standardized, trial-and-error approaches cannot individualize treatment to meet each patient's needs.
All chemotherapy treatments have toxicities, some more than others.
The role of the laboratory is to ensure that the most effective, least toxic treatments are selected the first time. This improves the likelihood of response and can help avoid toxic treatment choices when other milder drug combinations appear effective.
Results are available within 7 days of receipt of your sample in the laboratory.
Yes. Leukemias, lymphomas and myelomas are excellent candidates for drug selection because the cancer cells are easy to obtain (blood tubes in many cases) and there are many good choices to select from.
So long as there are enough cancer cells in circulation or in the bone marrow (generally 30% or more) these offer great opportunities to select active drugs. Some of our earliest work was conducted in these very diseases.
Patients with fluid accumulations in the lung (pleural effusion) or abdomen (ascites) can have these removed and sent right in the glass containers used by the doctor in their office. Just have the doctor add heparin so the fluid doesn't form a clot.
These fluid samples can be great sources of cancer cells and are generally easy to obtain.
For solid tumors like lung, breast, colon, ovary, etc. we request a cubic centimeter (about 1 gram) of tissue. Specimen can come from the actual tumor or from distant (metastatic) sites including lymph nodes.
The larger the sample that we receive, the more drugs and combinations we can test. Biopsies sometimes contain necrotic (dead) tissue, fat, and non-cancerous cells so the more we get the better.
For cancerous fluids (pleural or ascites) we request 500 to 1000 ml of fluid but can sometimes work with less. Again fluids must have heparin added.
For blood-borne cancers, we require at least 10 ml to 20 ml of blood or at least 1-3 ml of bone marrow.
Note: Solid tumor “Needle biopsies” usually do NOT contain enough cancer cells for our purposes and we do not encourage them unless pre-arranged with our physicians.
Patients on active chemotherapy must wait until the effects of the current drugs wear off (generally 2-3 weeks).
This is because the drugs administered can still have an effect on the health of the cancer cells (even if drugs aren't working very well). To avoid getting cells that are damaged and may give inaccurate results in the laboratory, we always wait 2 to 3 weeks before testing.
Yes, we can arrange to have your sample collected where you live and shipped overnight to our laboratory in Long Beach, CA.
Contact us and we will be happy to assist you with a specimen transportation kit and specific handling instructions.
Our lab receives samples from all over the US and internationally.
No, and this is a critical point.
The tests offered by most medical centers are known as genomic analyses.
These use the patient's DNA to look for mutations and other changes in each patient's gene makeup that might guide drug selection. Although the concept is appealing, in reality, a minority of patients have genetic changes that can be used for therapy.
Indeed, several clinical trials have failed to show meaningful benefit for patients with advanced cancer who received genomic-test selected drugs, except for a very small number of well-established targets like HER2 in breast, BCR-abl in leukemia and EGFr and ALK in lung.
This reflects the extremely complex nature of human cancer and the fact that genes are only the beginning of the long process of cancer development.
Each human cancer reflects all of its genes both mutated and normal acting together to create what we recognize as a malignant tumor. Only functional analyses can capture each patient's tumor in real time and provide insights that can inform drug selection and treatment decisions.
Cancers arise from cells that have learned certain tricks to enhance their survival so they can outlive their normal counterparts. (This is the subject of Dr. Nagourney's book Outliving Cancer, available on Amazon).
These transformed (cancerous) cells interact directly with their micro-environment. Cancer cells "talk" to each other and to all the surrounding cells using chemical signals like growth factors and byproducts of metabolism. Blood vessels, immune cells and connective tissues (stroma) all participate and contribute to the cancer process.
This is why it is absolutely essential to test cancers in their own natural clusters known as "microspheroids". We isolate these 3-dimensional structures directly from each patient's tumor to test drugs and combinations. It is because we capture cancer in its native state that our approach is the most accurate platform for response prediction.
Our job is to assist every patient to be sure that they receive the most effective, least toxic combinations available. We work with oncologists all over the world to see that this is accomplished.
If you do not have an oncologist or your doctors will not work with you to achieve this goal then Dr. Nagourney, who is triple board certified in Internal Medicine, Hematology, and Oncology and a practicing clinical oncologist in Southern California will see that you get the right treatment the first time, every time.