Ja. Mckay et al., Application of the enrichment approach to identify putative markers of response to 5-fluorouracil therapy in advanced colorectal carcinomas, INT J ONCOL, 17(1), 2000, pp. 153-158
A wide range of tumor response is seen amongst patients with the same stage
of colorectal cancer, even with the use of uniform chemotherapy. The signi
ficant economic and personal impact of chemotherapy provides the impetus fo
r the identification of markers of response for use in guiding patient trea
tment. However, practical constraints prevent evaluation of all putative ma
rkers in a definitive manner. In this study, the enrichment approach was ev
aluated by examining the expression of a panel of putative response markers
in selected patient populations with advanced colorectal cancer (i.e., tho
se demonstrating the best and the poorest clinical response to a standardiz
ed 5-fluorouracil/folinic acid chemotherapy regimen). Patients showing a go
od response had a significantly increased survival when compared with poor
responders (P=0.0013), Markers were then ranked for clinical importance bas
ed on differences in expression between the two groups. This allows for the
relatively rapid and inexpensive investigation of multiple markers, using
defined patient groups. Bcl-2 overexpression in primary colorectal tumor sp
ecimens was found to correlate with clinical response of metastatic deposit
s to chemotherapy (P=0.044), as did the site of the primary tumor (P=0.011)
. However, no clear association was observed between response status and th
e other examined factors (p53, PCNA, TP, MMPs 1, 2 or 9, TIMPs 1 or 2, TS,
Dukes' stage at initial diagnosis, histological grade, sex or age). This ap
proach has allowed prioritization of markers of clinical response on which
larger, statistically definitive studies will be performed.