Ex vivo drug response profiling for response and outcome prediction in hematologic malignancies: the prospective non-interventional SMARTrial.

Nora Liebers, Peter-Martin Bruch, Tobias Terzer, Miguel Hernandez-Hernandez, Nagarajan Paramasivam, Donnacha Fitzgerald, Heidi Altmann, Tobias Roider, Carolin Kolb, Mareike Knoll, Angela Lenze, Uwe Platzbecker, Christoph Röllig, Claudia Baldus, Hubert Serve, Martin Bornhäuser, Daniel Hübschmann, Carsten Müller-Tidow, Friedrich Stölzel, Wolfgang Huber, Axel Benner, Thorsten Zenz, Junyan Lu, Sascha Dietrich

Journal: Nature cancer 2023;4(12):1648-1659

PMID: 37783805

Abstract

Ex vivo drug response profiling is a powerful tool to study genotype-drug response associations and is being explored as a tool set for precision medicine in cancer. Here we conducted a prospective non-interventional trial to investigate feasibility of ex vivo drug response profiling for treatment guidance in hematologic malignancies (SMARTrial, NCT03488641 ). The primary endpoint to provide drug response profiling reports within 7 d was met in 91% of all study participants (N = 80). Secondary endpoint analysis revealed that ex vivo resistance to chemotherapeutic drugs predicted chemotherapy treatment failure in vivo. We confirmed the predictive value of ex vivo response to chemotherapy in a validation cohort of 95 individuals with acute myeloid leukemia treated with daunorubicin and cytarabine. Ex vivo drug response profiles improved ELN-22 risk stratification in individuals with adverse risk. We conclude that ex vivo drug response profiling is clinically feasible and has the potential to predict chemotherapy response in individuals with hematologic malignancies beyond clinically established genetic markers.

© 2023. The Author(s).

Address: Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.; Department of Medicine V, Heidelberg University Hospital, Heidelberg, Germany.; Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany.; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.; Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Aachen Bonn Cologne Düsseldorf, Germany.; Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.; Department of Medicine V, Heidelberg University Hospital, Heidelberg, Germany.; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.; Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Aachen Bonn Cologne Düsseldorf, Germany.; Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany.; Department of Medicine V, Heidelberg University Hospital, Heidelberg, Germany.; Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany.; Department of Medicine V, Heidelberg University Hospital, Heidelberg, Germany.; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.; European Molecular Biology Laboratory (EMBL), Heidelberg, Germany.; University Hospital TU Dresden, Dresden, Germany.; Leipzig University Hospital, Leipzig, Germany.; Department of Internal Medicine II, University Hospital of Kiel, Kiel, Germany.; Department of Internal Medicine II, University Hospital of Frankfurt Main, Frankfurt am Main, Germany.; Computational Oncology Group, Molecular Precision Oncology Program, NCT Heidelberg and DKFZ, Heidelberg, Germany.; Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany.; German Cancer Consortium (DKTK), Heidelberg, Germany.; Department of Medicine V, Heidelberg University Hospital, Heidelberg, Germany.; Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany.; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.; European Molecular Biology Laboratory (EMBL), Heidelberg, Germany.; Department of Medical Oncology and Hematology, Universitätsspital & Universität Zürich, Zürich, Switzerland.; The LOOP Zürich-Medical Research Center, Zürich, Switzerland.; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.; European Molecular Biology Laboratory (EMBL), Heidelberg, Germany.; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.; Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany. [email protected].; Department of Medicine V, Heidelberg University Hospital, Heidelberg, Germany. [email protected].; Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany. [email protected].; Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany. [email protected].; Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Aachen Bonn Cologne Düsseldorf, Germany. [email protected].; European Molecular Biology Laboratory (EMBL), Heidelberg, Germany. [email protected].; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany. [email protected].
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