Travera Ovarian Cancer Drug Panel

UpToDate Drugs Additional NCCN Drugs
1. Olaparib (Lynparza) 14. Oxaliplatin (Eloxatin)
2. Paclitaxel (Taxol) 15. Entrectinib (Rozlytrek/ALK))
3. Carboplatin (Paraplatin) 16. Trametinib (Mekinist/MEK)
4. Cisplatin (Platinol) 17. Sorafenib (Nexavar/RAF/MEK/VEGFR)
5. Cyclophosphamide (Cytoxan) 18. Larotrectinib (Vitrakvi/NTRK)
6. Etoposide (VP-16) 19. Pazopanib (Votrient/VEGFR)
7. Topotecan (Hycamtin) 20. Binimetinib (Mektovi/MEK)
8. Gemcitabine (Gemzar)
9. Doxorubicin (Adriamycin)
10. Docetaxel (Taxotere)
11. Rucaparib (Rubraca)
12. Niraparib (Zejula)
13. Tamoxifen (Soltamox)

Organization of Travera Ovarian Cancer Drug Panel
The Travera Ovarian Cancer Drug Panel consists of two sections: (1) the UpToDate Drugs section includes the drugs recommended by UpToDate, and (2) the Additional NCCN Drugs section includes drugs that are in the NCCN guidelines for Ovarian cancer patients but are not included in UpToDate. These may include drugs for earlier-stage cancer patients that UpToDate does not include in its recommendation for late-stage patients, but that could be safely used and reimbursed if the oncologist chose to do so.

UpToDate Drugs Missing from the Travera Drug Panel
There are three drugs recommended in UpToDate that are not included in the Travera drug panel: (1) Bevacizumab (Avastin), (2) Pemetrexed (Alimta), and (3) Pembrolizumab (Keytruda). Travera is not CLIA certified to test Bevacizumab or Pemetrexed. Pembrolizumab is tested under our separate panel of checkpoint inhibitors, which we test whenever there are sufficient live T cells in the sample.

Selection of the Additional NCCN Drugs
The Additional NCCN Drugs are selected based of a subjective analysis of the drugs in the NCCN guidelines that are not included in UpToDate. The Additional NCCN Drugs section includes oxaliplatin, a platinum drug that is included in the NCCN Guideline drugs but excluded from UpToDate. The Additional Drugs section also includes the NCCN Ovarian cancer drugs that are popular targeted inhibitors for some of the most common mutations (ALK, MEK, NTRK, RAF, VEGFR). The UpToDate panel includes three popular PARP inhibitors (Rucaparib Olaparib, and Niraparib), so PARP inhibitors are not included in the NCCN Additional Drugs section.

Order of Testing Drugs
The order of drugs is crucial as it dictates the testing sequence, especially when there may not be enough live cancer cells to test the entire panel. The UpToDate drugs are sorted by the Objective Response Rate (ORR) reported in UpToDate, regardless of platinum sensitivity or biomarker status (Click here for a summary of the ORRs of the UpToDate drugs). The Additional NCCN drugs are sorted by chemotherapies first and then the targeted inhibitors. If you want to change the drug testing order, please get in touch with us.

Frequently asked questions

  • If none of the drugs in the panel show a response, you may want to run a different panel of 20 drugs, including off-label drugs that are FDA approved but not indicated for your cancer. This will require an additional biopsy, and raises issues of insurance reimbursement should you decide to use an off-label drug.

  • No, the 2-day turnaround time is not affected by the number of drugs tested.

  • Yes, we can mix two or more drugs together and test them in combination against live cancer cells. We cannot mix checkpoint inhibitors with the other drugs we test, as they test different cells: the checkpoint inhibitors test the response of the T cells, whereas all the other drugs test the response of the cancer cells.

  • Yes, we have developed a method for estimating the response of any two-drug combination from the responses of the individual drugs. The key limitation of this method is that it produces a range of possible responses, not a single point estimate of response. The range is caused by uncertainty in the degree of independence of the two drugs, which we cannot measure. Click on this link for a detailed description of our drug combination method.

  • Mixing the drugs accounts for the independence of the drugs, which the algorithmic combination of monotherapy results cannot do. But the number of combinations that can be tested via mixing is limited to fewer than 20, whereas the number of combinations that can be estimated by combining the results of monotherapy testing is far greater, up to 380 combinations from a panel of 20 drugs.

  • No, the test provides no personalized information about duration of response. The only duration of response information comes from clinical trials.

  • Yes, the test can be run again and again, following each recurrence, to find new effective personalized drugs as your cancer changes. In an ideal situation, the duration of response would be the sum of the durations of response of a personalized drug identified at each testing cycle.

  • We require live cells sent to use the same day as they are biopsied. If you cannot have another, then you are not eligible for the Travera test.

  • No, our test requires fresh live cancer cells.

  • No, some biopsies capture so few live cancer cells, or those cells die during shipment, that we cannot run the test. We require 5,000 live cancer cells per drug tested. If we have fewer than 100,000 live cancer cells we will test as many drugs as possible, in the order of the drug panel. But if we have no live cancer cells we will not run the test.

  • No, there is no guarantee that your cancer will be sensitive to any of the drugs we test. But the more drugs we test, the more likely we are to detect a response to at least one drug.

  • If your tumor is highly heterogenous, there may be no sub-clonal population of cancer cells large enough to generate a positive test result.

  • No, if the cancer cells collected in the biopsy are unrepresentative of the cancer, then the test will produce misleading results.