Qiu YX, Jian KY, Xu QR, Lu X, Jia BL, Jiang L, Liang F. OncoVee™-mini-patient-derived xenograft guided adjuvant chemotherapy treatment for resectable gastric cancer. World J Gastrointest Oncol 2026; 18(7): 118050 [DOI: 10.4251/wjgo.v18.i7.118050]
Corresponding Author of This Article
Feng Liang, PhD, Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. lfpeakcool@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yu-Xuan Qiu, Feng Liang, Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Kai-Yu Jian, Qian-Ru Xu, Xin Lu, Bao-Lei Jia, Lin Jiang, Department of General Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Qiu YX and Jian KY drafted the manuscript, collected clinical data, and performed the statistical analyses, contributed equally to this work as co-first authors; Liang F conceptualized and designed the study; Xu QR and Lu X assisted with data curation and patient follow-up assessments; Jia BL and Jiang L contributed to the methodology, specifically regarding the mini patient-derived xenograft testing procedures and imaging evaluations; Liang F critically revised the manuscript for important intellectual content and supervised the project. All authors read and approved the final manuscript.
Institutional review board statement: The study protocol was reviewed and approved by the Ethics Committee of Tongxin County People’s Hospital of Ningxia, No. 001.
Informed consent statement: All patients signed a written informed consent form prior to their inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Feng Liang, PhD, Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. lfpeakcool@126.com
Received: January 27, 2026 Revised: February 21, 2026 Accepted: April 8, 2026 Published online: July 15, 2026 Processing time: 167 Days and 1 Hours
Abstract
BACKGROUND
Most patients with resectable gastric cancer require postoperative adjuvant chemotherapy, and appropriate drug or regimen selection is crucial for improving their prognosis. The clinical application in antitumor drug sensitivity testing for gastric cancer is challenging owing to low success rates and prolonged establishment times involving gastric cancer patient-derived xenograft models.
AIM
To determine whether OncoVee™-mini patient-derived xenograft (MiniPDX)-guided adjuvant chemotherapy improves outcomes for patients with resectable gastric cancer compared with conventional guideline-based chemotherapy.
METHODS
This retrospective study, comprising 36 enrolled patients with resectable gastric cancer, divided patients into a MiniPDX group (OncoVee™-MiniPDX model used to screen for the most sensitive drug or regimen and to guide clinical treatment) or an experiential treatment group (patients received conventional drug treatment according to clinical guidelines, without MiniPDX-based drug sensitivity screening), based on their preferences. The primary endpoint was recurrence-free survival (RFS); secondary endpoints were overall survival (OS).
RESULTS
Baseline characteristics in the MiniPDX and experimental treatment groups (16 and 20 patients, respectively) were balanced. The mean RFS was 48.2 [95% confidence interval (CI): 37.9-58.5] and 32.7 (95%CI: 23.7-41.7) months, respectively. Drug susceptibility testing using the MiniPDX model significantly improved patients’ RFS (mean: 48.2 months vs 32.7 months, respectively; P = 0.025). The mean OS was 54.5 (95%CI: 46.9-62.1) and 43.5 (95%CI: 36.2-50.7) months, respectively, indicating a significant OS benefit with MiniPDX-guided therapy (mean: 54.5 months vs 43.5 months, respectively; P = 0.036). Multivariate Cox analysis indicated that MiniPDX testing (adjusted hazard ratio = 0.266, 95%CI: 0.087-0.816, P = 0.021) was a protective factor for RFS and for OS (adjusted hazard ratio = 0.83, 95%CI: 0.081-0.997, P = 0.050). Log-rank and multivariate Cox analyses demonstrated superior RFS and OS in the Mini-PDX group.
CONCLUSION
The Oncovee™-MiniPDX model can be used to detect drug sensitivity in postoperative adjuvant therapy for gastric cancer and improve the RFS and OS for patients with resectable gastric cancer. Further studies are needed to validate our findings.
Core Tip: In this retrospective study, OncoVee™-mini patient-derived xenograft-guided postoperative adjuvant chemotherapy significantly improved recurrence-free survival and overall survival in patients with resectable gastric cancer compared with conventional experience-based treatment. The mini patient-derived xenograft platform enables rapid in vivo drug sensitivity testing within 7 days and may provide a feasible strategy for individualized precision chemotherapy selection in clinical practice.
Citation: Qiu YX, Jian KY, Xu QR, Lu X, Jia BL, Jiang L, Liang F. OncoVee™-mini-patient-derived xenograft guided adjuvant chemotherapy treatment for resectable gastric cancer. World J Gastrointest Oncol 2026; 18(7): 118050
Gastric cancer is among the most common malignant tumors and the fifth leading cause of cancer-related death worldwide[1]. In China, gastric cancer accounts for approximately half of all gastric disease-related incidences and mortalities[1,2]. While gastric cancer-related incidence and mortality rates have decreased in the past few decades, survival rates for patients with gastric cancer have shown less improvement than those of other gastrointestinal cancers[3,4]. Despite postoperative adjuvant chemotherapy being an effective intervention for enhancing the prognosis of gastric cancer, a significant proportion of patients exhibit poor responsiveness to this therapeutic approach. Therefore, identifying the most sensitive adjuvant chemotherapy regimen for individual patients is crucial to improving their prognosis.
However, in current clinical practice, the selection of postoperative adjuvant chemotherapy regimens is primarily based on clinicopathological staging systems, guideline recommendations, and physician experience rather than direct evidence of individual tumor drug sensitivity[5-8]. Large randomized clinical trials have established the overall survival (OS) benefit of adjuvant chemotherapy, but they do not account for inter-patient tumor heterogeneity and differential drug responsiveness. Consequently, this empirical approach may result in suboptimal therapeutic efficacy, unnecessary treatment-related toxicity, and delayed identification of ineffective regimens. Therefore, reliable and rapid drug sensitivity testing methods are urgently needed to guide individualized adjuvant chemotherapy selection. Patient-derived xenografts (PDX) are animal models wherein tumor tissue from a patient is directly implanted into immunodeficient mice, thereby generating a model that recapitulates the biological characteristics of human tumors. Currently, PDX is an effective approach for evaluating the efficacy of antitumor drugs in the preclinical stage[9-11]. Compared to traditional cell lines or genetically engineered animal models, the PDX model inherits the heterogeneity of the parental tumor tissue and preserves its molecular and histopathological characteristics[12-15], thereby enabling antitumor drug sensitivity testing for individual patients. Several studies have confirmed that PDX models can predict tumor patient sensitivity to various chemotherapy regimens, thereby facilitating clinical decision-making. The overall consistency between patients’ clinical treatment responses and PDX drug sensitivity test results can reach over 70%[12,16-21].
While the PDX model offers substantial advantages for antitumor drug sensitivity testing, inherent limitations that impede its clinical application have been observed. The tumor xenograft establishment process often requires several months to complete[22]. Moreover, across multiple tumor types, the success rate of tumor xenografting is typically < 50%[22,23]. Specifically, owing to the low success rate and prolonged establishment time of gastric cancer PDX models, their clinical application in antitumor drug sensitivity testing for gastric cancer has been challenging (Table 1).
Table 1 Comparison of patient-derived xenograft and mini patient-derived xenograft for gastric cancer.
To address the limitations of the PDX model, the Laboratory for Innovated Diagnosis and Experimental Therapeutics (LIDE) (LIDE Biotech Co., Ltd., Shanghai, China) developed the mini PDX (MiniPDX) test, an antitumor drug sensitivity testing method with faster detection speed and higher success rates using hollow fiber capsule implantation technology. This drug-sensitivity testing method can help predict the clinical response of patients to chemotherapy and targeted therapies. Furthermore, it provides a more rapid and efficient approach for evaluating the sensitivity of individual patients to antitumor drugs compared to the traditional PDX model[24]. The MiniPDX test uses hollow fiber capsule implantation technology to encapsulate primary tumor cells within immunodeficient mice, enabling patient-derived primary tumor cells to survive and proliferate. This approach has achieved a higher detection rate and has partially overcome the low success rate observed in the PDX models. Moreover, MiniPDX drug sensitivity testing does not require pre-establishment of a PDX model, thereby avoiding the low success rate associated with traditional PDX model development. Compared with the PDX model, these two improvements are likely to help promote MiniPDX in clinical practice[24-28], particularly for selecting individualized postoperative adjuvant chemotherapy regimens for patients with resectable gastric cancer. We hypothesized that the administration of more precise postoperative adjuvant chemotherapy regimens would improve the prognosis of patients with gastric cancer. Therefore, this study aimed to evaluate the efficacy of OncoVee™-MiniPDX-guided therapy in these patients.
MATERIALS AND METHODS
Participant selection
We enrolled patients with histologically confirmed resectable gastric cancer treated at The Fifth Medical Center of Chinese PLA General Hospital, between June 2019 and December 2022. All enrolled patients were followed up, and the final follow-up was conducted in September 2024. The inclusion criteria comprised patients: (1) Aged ≥ 18 years; (2) With D2 radical resection and complete tumor resection (R0) performed within 21-60 days before the first chemotherapy cycle; (3) With stage I, II or III gastric or gastroesophageal junction adenocarcinoma confirmed according to postoperative pathological staging; (4) With the requirement and ability to undergo postoperative adjuvant chemotherapy; (5) With a postoperative Eastern Cooperative Oncology Group Performance Status score of 0 or 1; and (6) With normal major organ function, including white blood cell count, ≥ 4 × 109/L; neutrophil count, ≥ 1.5 × 109/L; platelet count, ≥ 100 × 109/L (without transfusion); bilirubin, ≤ 1.5 × upper limit of normal (ULN); aspartate aminotransferase and alanine aminotransferase, ≤ 2.5 × ULN; hemoglobin, ≥ 90 g/L (without transfusion); serum creatinine, ≤ 1.5 × ULN; and serum albumin, ≥ 25 g/L.
The exclusion criteria comprised patients: (1) Who were pregnant or lactating; (2) With any active infection requiring intravenous antibiotic therapy; (3) With a history of prior neoadjuvant chemotherapy or radiotherapy; (4) With distant metastasis; and (5) With severe cardiovascular disease, myocardial infection, cerebrovascular accident, arrhythmia, or unstable angina within 3 months of enrollment. In this non-randomized study, the patients were enrolled consecutively. All eligible patients were recommended the MiniPDX test; those who voluntarily accepted MiniPDX testing were enrolled in the MiniPDX group, and those who declined were enrolled in the experiential treatment group. Finally, 36 patients were included in the final analysis, comprising 16 in the MiniPDX group and 20 in the experiential treatment group. This study complied with the principles of the Declaration of Helsinki.
OncoVee™-MiniPDX model (MiniPDX test)
The chemotherapy regimen for patients in the MiniPDX group was selected based on the MiniPDX drug sensitivity test, with the regimen demonstrating the lowest relative proliferation rate [treated-to-control ratio (T/C)]. Two mice were used per dosing regimen, with three capsules implanted per mouse, corresponding to six replicates per dosing regimen. For each patient, a blank control group consisting of two untreated mice was established. The MiniPDX test was performed using the OncoVee™-MiniPDX kit (LIDE Biotech Co., Ltd., Shanghai, China). Patient tumor tissues were digested into a tumor cell suspension and transferred into Hank’s Balanced Salt Solution-washed capsules made from hollow fiber membranes with a pore size < 500 kDa. These capsules deliver media to the cells, in a manner similar to how the blood system supplies nutrients through a capillary network in vivo. BALB/c nude mice (SLARC Corporation, Shanghai, China), aged 4-6 weeks and weighing 15-20 g, were selected for subcutaneous implantation. The OncoVee™-MiniPDX capsule was placed subcutaneously on their backs. On day 1 post-inoculation, the tumor-bearing mice received chemotherapy drugs for 7 days (Figure 1A).
Figure 1 OncoVee™-mini patient-derived xenograft flow diagram and the drug regimen of the mini patient-derived xenograft test.
A: The OncoVee™-mini patient-derived xenograft (MiniPDX) flow is as follows: Tumor cells digested from fresh surgical samples were placed into six capsules and subcutaneously implanted into two 4-week-old BALB/c nude mice. Seven days after administration, the capsules were collected and drug sensitivity was assessed using cell viability tests. Based on the results of the MiniPDX, the best regimen is selected for personalized chemotherapy; B: Results of MiniPDX test (treated-to-control ratio); C: The specific dose, routes of administration, and cycle used in MiniPDX testing; D: Assessment of the regimens of the two groups to evaluate the influence of the MiniPDX test on regimen selection in clinical practice (Fisher’s exact test). MiniPDX: Mini patient-derived xenograft.
All MiniPDX group patients underwent MiniPDX testing using the three treatment regimens most likely to be effective, selected by the investigator based on clinical experience from the following seven treatment regimens: (1) Apatinib; (2) Oxaliplatin + S-1; (3) Nab-paclitaxel (albumin-bound paclitaxel); (4) Oxaliplatin + S-1 + nab-paclitaxel; (5) Apatinib + S-1; (6) Oxaliplatin + capecitabine; and (7) Nab-paclitaxel + S-1. All seven regimens were recommended by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (1st Edition, 2018) and the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for the Diagnosis and Treatment of Gastric Cancer (2018). The dosage and administration were as follows: Oxaliplatin, 5 mg/kg, intraperitoneally once weekly; S-1, 10 mg/kg, po (per os), day 1-5, once daily; apatinib, 100 mg/kg, po, day 1-7, once daily; nab-paclitaxel, 20 mg/kg, intravenously, day 1-5, once daily; and capecitabine, 400 mg/kg, po, day 1-7, once daily.
Additionally, 7 days after the first dose, tumor cell viability was assessed in relative fluorescent units (RFUs) using a Cell Titer-Glo® Luminescent Cell Viability Assay (Promega, Madison, WI, United States) to evaluate the antitumor activity of each drug. The proliferation rate was calculated using the following formula: Relative proliferation rate (T/C ratio) = (RFU_D7 - RFU_D0) chemotherapy group/(RFU_D7 - RFU_D0) blank control group.
The T/C ratio was defined as the proliferation rate of tumor cells in the chemotherapy group relative to that in the blank control group, 7 days after drug administration (blank control group mice received no drug treatment) (Figure 1). A T/C ratio < 55% was considered the response cutoff value, as confirmed in previous studies[27,28]. All animal experimental procedures were reviewed and approved by the Institutional Animal Care and Use Committee of LIDE Biotech Co., Ltd., and all the procedures were performed in accordance with the National Institutes of Health Guidelines for the Care and Use of Laboratory Animals.
Conventional chemotherapy
Patients in the experimental group did not undergo MiniPDX testing. They received chemotherapy according to NCCN Clinical Practice Guidelines in Oncology (1st edition, 2018) and CSCO Clinical Guidelines for the Diagnosis and Treatment of Gastric Cancer (2018). Treatment decisions were made by at least two independent senior medical professionals for the same seven treatment regimens as the MiniPDX group: (1) Apatinib; (2) Oxaliplatin + S-1; (3) Nab-paclitaxel (albumin-bound paclitaxel); (4) Oxaliplatin + S-1 + nab-paclitaxel; (5) Apatinib + S-1; (6) Oxaliplatin + capecitabine; and (7) Nab-paclitaxel + S-1.
Outcomes and measurement
The primary endpoint was recurrence-free survival (RFS) among the enrolled patients, and the secondary endpoint was OS. Follow-up was performed monthly during treatment and every 3 months after treatment until death or loss to follow-up. Follow-up assessments included medical history taking, physical examination, and evaluation of disease progression. RFS and OS were defined as the time from completion of surgery to the detection of disease recurrence or patient death. All patients underwent routine abdominal computed tomography (CT) scans at baseline and during follow-up using a CT scanner (GE Healthcare, Little Chalfont, United States). CT images were processed using the Neusoft Slice software package (version 5.5). At least two radiologists with > 10 years of experience performed the imaging assessments. Patients underwent monthly imaging evaluations during chemotherapy and every 3 months after chemotherapy completion until disease recurrence or death.
Statistical analysis
IBM Statistical Package for the Social Sciences Statistics 25.0 (IBM, United States) software was used for data analysis and visualization. Normally distributed data are expressed as mean ± SD, whereas non-normally distributed data are expressed as median and range. Unpaired t-tests were used to analyze normally distributed continuous variables, and categorical variables were analyzed using Pearson’s χ2 test. Univariate (log-rank test) and multivariate analyses (Cox proportional hazards model) were used to evaluate potential independent risk factors. The Kaplan-Meier method was used to analyze RFS and OS. Statistical significance was set at P < 0.05.
RESULTS
Patients’ baseline characteristics
From June 2019 to December 2022, 43 patients with gastric/gastroesophageal junction cancer signed an informed consent form and were included in the study. All patients were followed up, and the final follow-up was conducted in September 2024. Among them, 23 patients underwent the MiniPDX test. Of these, one patient did not receive adjuvant chemotherapy because of personal choice, one patient had a failed MiniPDX test, and five patients were lost to follow-up after surgery. The remaining 16 patients in the mini-PDX group were included in the final analysis. Additionally, 20 patients who received postoperative adjuvant chemotherapy according to NCCN or CSCO guidelines during the same period but who did not receive OncoVee™-MiniPDX drug sensitivity testing were enrolled in the experiential treatment group (Supplementary Tables 1 and 2). The baseline characteristics of the two groups were similar, with no statistically significant differences (Table 2).
Table 2 Patients’ demographic and tumor characteristics, n (%).
Efficacy prediction and medication regimens according to the MiniPDX test
Using tumor samples obtained after curative surgery, each patient in the MiniPDX group underwent a MiniPDX test consisting of three chemotherapy regimens. The regimens were selected by the investigators based on their clinical experience using the following seven treatment options: (1) Apatinib; (2) Oxaliplatin + S-1; (3) Nab-paclitaxel (albumin-bound paclitaxel); (4) Oxaliplatin + S-1 + nab-paclitaxel; (5) Apatinib + S-1; (6) Oxaliplatin + capecitabine; and (7) Nab-paclitaxel + S-1. All 16 patients in the MiniPDX group received adjuvant chemotherapy with the most sensitive regimen based on the MiniPDX test results. The test dose of each drug was fixed (Figure 1C).
Based on the MiniPDX results, six regimens, excluding apatinib, showed potential efficacy in susceptibility tests, with both mean and median pooled T/C ratios < 55%. The average proliferation rates of cancer cells treated with apatinib, oxaliplatin + S-1, nab-paclitaxel (albumin-bound paclitaxel), oxaliplatin + S-1 + nab-paclitaxel, apatinib + S-1, oxaliplatin + capecitabine, and nab-paclitaxel + S-1 were 61.33 ± 20.84, 50.88 ± 20.16, 50.12 ± 15.63, 37.50 ± 33.69, 38.20 ± 13.52, 12.67 ± 12.58, and 32.00 ± 13.75, respectively (Figure 1B). Sensitivity to the same drug varied considerably in mice inoculated with tumors from different patients. For example, mice administered apatinib had the highest T/C rate (84%) and the lowest T/C rate (27%), whereas mice administered oxaliplatin + S-1 had the highest T/C rate (92%) and the lowest T/C rate (13%), implying the need for individualized therapy. Additionally, we compared the regimen choices between the two groups to evaluate the effect of MiniPDX on regimen selection. No statistically significant differences were observed between the two groups (Figure 1D).
Survival outcomes and subgroup analysis
The mean RFS was 48.2 months [95% confidence interval (CI): 37.9-58.5] in the MiniPDX group and 32.7 months (95%CI: 23.7-41.7) in the experiential treatment group. The MiniPDX test significantly improved the patients’ RFS (mean RFS: 48.2 months vs 32.7 months; P = 0.025) (Figure 2A). The mean OS was 54.5 months (95%CI: 46.9-62.1 months) in the MiniPDX group and 43.5 months (95%CI: 36.2-50.7 months) in the experiential treatment group. The MiniPDX test significantly improved the patients’ OS (mean OS: 54.5 months vs 43.5 months; P = 0.036) (Figure 2B). Additional analyses were performed based on baseline characteristics to explore the findings in more detail. Multivariate Cox analysis suggested that the MiniPDX test [adjusted hazard ratio (aHR) = 0.266, 95%CI: 0.087-0.816; P = 0.021] was a protective factor for patients’ RFS (Table 3), and similar conclusions were observed in patients’ OS (aHR = 0.83, 95%CI: 0.081-0.997; P = 0.050) (Table 4). Additionally, better American Joint Committee on Cancer (AJCC) staging results were a protective factor for patients’ RFS (AJCC stage 1: AHR = 0.536, 95%CI: 0.330-0.869; P = 0.011) (Table 3).
Figure 2 Recurrence-free survival and overall survival results of this study.
A: Gastric cancer patients who received treatment based on mini patient-derived xenograft results had better recurrence-free survival compared to those in experimental treatment group; B: Gastric cancer patients who received treatment based on mini patient-derived xenograft results had better overall survival compared to those in experimental treatment group.
Table 3 Univariate and multivariate Cox proportional hazards regression analysis of recurrence-free survival.
Characteristics
Mean recurrence-free survival months
P value
Multivariate adjusted hazard ratio (95% confidence interval)1
Several large-scale randomized controlled clinical trials have consistently confirmed that postoperative adjuvant chemotherapy confers significant survival benefits to patients with gastric cancer[5,29-31], thereby establishing it as a cornerstone of standard treatment protocols for advanced gastric cancer following surgical resection. However, variations exist in the recommendations for adjuvant chemotherapy regimens across clinical studies and practice guidelines and across different regions and countries. This discrepancy is likely attributable to diverse factors such as ethnic differences, variations in pathological subtypes, epidemiological characteristics, diagnostic methodologies, and clinical practice patterns[32]. Consequently, personalized selection of optimal adjuvant chemotherapy regimens tailored to individual patient profiles has emerged as a critical and pressing area of research focus in the field.
In our study, the MiniPDX chemosensitivity test was performed on tumor cells enriched from surgical specimens of 16 patients with gastric cancer, and individualized chemotherapy regimens were assigned based on the test results. The mean RFS and OS in the MiniPDX group were approximately 48.2 months and 54.5 months, respectively, compared to 32.7 months and 43.5 months in the experiential treatment group, respectively. The MiniPDX test significantly improved RFS (mean RFS: 48.2 months vs 32.7 months, P = 0.025) and OS (mean OS: 54.5 months vs 43.5 months, P = 0.036). These improvements were also confirmed in multivariate Cox analysis (RFS: AHR = 0.266, 95%CI: 0.087-0.816; P = 0.021; OS: AHR = 0.83, 95%CI: 0.081-0.997; P = 0.050). Additionally, better AJCC staging results were a protective factor for patients’ RFS (AJCC stage 1: AHR = 0.536, 95%CI: 0.330-0.869; P = 0.011). Thus, the improvements in RFS and OS observed in the MiniPDX group suggest that MiniPDX-guided adjuvant chemotherapy may provide better prognostic outcomes than conventional chemotherapy based on clinical experience in patients with gastric cancer requiring postoperative adjuvant therapy. The MiniPDX technology can help clinicians identify the most sensitive individualized adjuvant chemotherapy regimen for patients with gastric cancer. The MiniPDX test showed statistically promising results across the cohort; however, it did not address some inherent independent risk factors, such as AJCC staging.
As the basis of MiniPDX technology, the PDX model can more accurately reflect the individual tumor characteristics of patients, leading to clinical attempts to use it to evaluate the antitumor drug sensitivity of individual patients[12,16-21]. However, the lengthy establishment time and low success rates for the PDX models have hindered the application of this technology to various cancers, including gastric cancer[22,23]. MiniPDX is an improved method for rapid in vivo detection of antitumor drug sensitivity based on the PDX model. It takes only 7 days to obtain drug sensitivity test results, and the detection success rate can reach 100% if sufficient patient tumor samples can be provided. Zhang et al[24] reported that the MiniPDX test showed 90% consistency in drug sensitivity test results with the PDX model, while improving the detection success rate and efficiency, with a positive value of 92%, a negative value of 81%, sensitivity of 80%, and specificity of 90%. These advantages make MiniPDX a more favorable method than PDX for the detection of individualized tumor drug sensitivities in clinical settings.
With the expansion of its clinical applications, the clinical value of the MiniPDX test has been further verified by the results of clinical studies on various cancers, including gastric cancer. Huang et al[33] used MiniPDX to guide the selection of chemotherapy regimens for 12 patients with platinum-resistant ovarian cancer, with the study showing a disease control rate of 75%. Similarly, Zhan et al[34] used MiniPDX to guide the selection of first-line chemotherapy regimens in 12 patients with gallbladder cancer. They reported that the median OS of patients in the MiniPDX group was 18.6 months (95%CI: 15.9-21.3 months) compared with 13.9 months (95%CI: 11.7-16.2 months) in the conventional chemotherapy group (HR = 3.18, 95%CI: 1.47-6.91; P = 0.030)[34]. Yang et al[35] used MiniPDX to guide the selection of adjuvant chemotherapy regimens in 42 patients with hepatocellular carcinoma following partial hepatectomy, reporting disease-free survival rates for patients in the MiniPDX group as significantly longer than those for patients in the control group (median disease-free survival: 25.8 months vs 18.2 months, HR = 2.19, 95%CI: 1.17-4.12; P = 0.022).
Ge et al[36] used MiniPDX to guide chemotherapy selection in 21 patients with metastatic gastric cancer. The median OS of patients in the MiniPDX group was 9.4 months (95%CI: 7.9-11.2) compared with 7.9 months (95%CI: 7.2-8.7) in patients who received standard chemotherapy (control group). Both univariate (control group vs MiniPDX group: HR= 2.586, 95%CI: 1.362-4.908; P = 0.004) and multivariate regression analyses (control group vs MiniPDX group: AHR = 4.288, 95%CI: 1.452-12.671; P = 0.008) indicated that the MiniPDX group had an advantage in OS[36]. Similar results have been reported for lung and kidney cancers[37,38].
This study had some limitations. The sample size was relatively small (n = 36), which may limit the statistical power and stability of the survival analyses. The wide CIs observed in multivariate analysis reflect this limitation, and our study findings should be interpreted with caution and validated in larger, multicenter randomized studies. Furthermore, the timing of MiniPDX testing and whether testing should be performed during adjuvant or neoadjuvant chemotherapy requires further investigation. Therefore, the conclusions of this study need to be validated through randomized controlled trials with larger sample sizes. However, our study findings indicated that a MiniPDX-guided precision chemotherapy regimen can effectively improve the prognosis of patients with gastric cancer. These findings may provide a meaningful exploratory basis for the future precise treatment of gastric cancer and other solid tumors.
Additionally, as this was a non-randomized retrospective cohort study in which treatment allocation was based on patient preference, potential selection bias cannot be completely excluded. Baseline characteristics between the two groups were comparable, but unmeasured confounding factors may have influenced treatment decisions and outcomes. Future prospective randomized controlled trials are required to minimize selection bias and validate these findings.
CONCLUSION
Treatment regimens guided by the MiniPDX model are expected to enhance survival outcomes and boost response rates in patients with gastric cancer. The Oncovee™-MiniPDX platform shows promising applicability for managing other types of aggressive tumors beyond gastric cancer. Nevertheless, additional well-designed clinical trials with larger sample sizes and longer follow-up periods are warranted to validate these preliminary findings and establish robust clinical evidence.
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