Seattle’s Presage Biosciences has developed a device which introduces small amounts of different chemotherapy drugs into a patient's tumor. The tumor is inspected after removal and the most effective of the drugs are used for post-surgical chemotherapy, resulting in more efficient, personalized cancer treatments. The new device is awaiting FDA approval, but is currently being used to facilitate development of new chemotherapy drugs.

One of the largest challenges faced by oncologists is finding an effective treatment for a particular patient that doesn’t cause the patient undue suffering. According to Dr. Jim Olson, a pediatric neuro-oncologist and scientist at Seattle Children’s Hospital and the Fred Hutchinson Cancer Research Center. “I am sick of writing prescriptions for kids to give them experimental therapies that have a 94 percent chance of failing and that will more than likely make them sick,” says Olson, who is also the founder of Presage.

Presage's new technology injects minute amounts ("about a fifth of a raindrop") of different cancer drugs into a tumor while it is still in the body. Once the tumor is removed, doctors can examine it to see which drugs killed its cancerous cells. The drugs that work best within the tumor can then be given in larger doses intravenously to fight the cancer throughout the body.

The picture above illustrates the clinical use of the new test. On the left is a photograph of a cross-section of a lung cancer tumor. Some time before removing the tumor, Presage's new device was used to compare various treatments – a standard chemotherapy regime, experimental drug A, experimental drug B, and a combination of A and B.

On the right appears the same slice of the tumor, viewed in induced fluorescence after staining the tissue with a marker that identifies dead tumor cells. The glowing areas reveal that the standard treatment killed a small number of tumor cells, as did drugs A and B alone. However, a large synergistic effect was seen where the combination of A and B had been administered. If the toxicities of the various drugs are on the same level, the choice of the combination of drugs A and B for post-surgical chemotherapy seems obvious.

Presage Biosciences is seeking FDA approval of the new test, and is currently carrying out a clinical study to support that goal.

Beyond personalizing cancer treatments, pharmaceutical companies could use this technique to evaluate new experimental treatments and drug combinations, a hot area of cancer drug research.

At present, pharmaceutical company Millennium is using Presage’s technology to test cancer drug combinations on solid tumors in lab animals to identify more effective treatments.

“The Presage technology is definitely unique,” says Mark Manfredi, senior director of cancer pharmacology at Millennium. "Being able to test drugs in the body is a huge advantage. We are able to then pursue a broad set of questions with the Presage technology faster than a traditional study where the drug is delivered systemically.”