CA2607149A1 - Predicting responsiveness to cancer therapeutics - Google Patents

Abstract

The invention provides for compositions and methods for predicting an individual's responsitivity to cancer treatments and methods of treating cancer. In certa in embodiments, the invention provides compositions and methods for predicting an individual's responsitivity to chemotherapeutics, including salvage agents, to treat cancers such as ovaria n cancer. The invention also provides reagents, such as DNA microarrays, software and computer systems useful for personalizing cancer treatments, and provides methods of conducti ng a diagnostic business for personalizing cancer treatments.

Description

PREDICTING RESPONSIVENESS TO CANCER THERAPEUTICS
STATEMENT REGARDING FEDERALLY SPONSORED
RESEARCH OR DEVELOPMENT

[0001] This invention was made with government support under NCI-U54 CA112952-and RO 1-CA 106520 awarded by the National Cancer Institute. The government has certain rights in the invention.

FIELD OF THE INVENTION

[0002] Cancer therapeutics are often effective only in a subset of patients.
In addition, chemotherapeutic drugs often have toxic side effects. To address this problem, it will be useful to predict which cancer therapeutics will be effective for a given patient.
This invention relates to a gene predictor set wherein altered expression of certain genes is correlated with high or low responsiveness to chemotherapeutic drugs. A tumor sample is collected from a patient and its gene expression profile is determined. This profile is then compared to a gene predictor set.
This comparison allows one to select the therapy that is most likely to be effective for the individual patient.

BACKGROUND OF THE INVENTION

[0003] Numerous advances in the development, selection, and application of chemotherapy agents, sometimes with remarkable successes as seen in the case of treatment for lymphomas or platinum-based therapy for testicular cancers (Herbst, R.S. et al. Clinical Cancer Advances 2005;
major research advances in cancer treatment, prevention, and screening - a report from the American Society of Clinical Oncology. J. Clin. Oncol. 24, 190-205 (2006)). In addition, in several instances, combination chemotherapy in the adjuvant setting has been found to be curative. However, most patients with clinically or pathologically advanced solid tumors will i,.
relapse and die of their disease. Moreover, administration of ineffective chemotherapy increases the probability of side-effects, particularly from cytotoxic agents, and consequently a decrease in quality of life (Herbst, R.S. et al. Clinical Cancer Advances 2005; major research advances in cancer treatment, prevention, and screening - a report from the American Society of Clinical Oncology. J. Clin. Oncol. 24, 190-205 (2006), Breathnach, O.S. et al. Twenty-two years of 10769217 1 DnC

phase III trials for patients with advanced non-small-cell lung cancer:
sobering results. J. Clin.
Oncol. 19, 1734-1742 (2001).).

[0004] Recent work has demonstrated the value in the use of biomarkers to select patients for various targeted therapeutics including tamoxifen, trastuzumab, and imatinib mesylate. In contrast, equivalent tools to select those patients most likely to respond to the commonly used chemotherapeutic drugs are lacking. A thorough understanding of drug resistance mechanisms should provide insight into how best to overcome resistance and, more importantly, the development of a strategy to match patients with drugs to which they are most likely to be sensitive and/or identify appropriate drug combinations for individual patient/patient groups is critical.

[0005] Throughout this specification, reference numbering is sometimes used to refer to the full citation for the references, which can be found in the "Reference Bibliography" after the Examples section. The disclosure of all patents, patent applications, and publications cited herein are hereby incorporated by reference in their entirety for all purposes.

BRIEF SUMMARY OF THE INVENTION

[0006] In one aspect, the invention provides a method of identifying an effective cancer therapy agent for an individual with a platinum-resistant tumor, comprising:
(a) obtaining a cellular sample from the individual; (b) analyzing said sample to obtain a first gene expression profile; (c) comparing said first gene expression profile to a platinum chemotherapy responsivity predictor set of gene expression profiles to identify whether said individual will be responsive to a platinum-based therapy; (d) if said individual is an incomplete responder to platinum based therapy, then comparing the first gene expression profile to a set of gene expression profiles comprising at least 5 genes from Table I that is capable of predicting responsiveness to other cancer therapy agents; thereby identifying whether said individual would benefit from the administration of one or more cancer therapy agents wherein said cancer therapy agents are not platinum-based.

[0007] In another aspect, the invention provides a method of treating an individual with i,.
ovarian cancer comprising: (a) obtaining a cellular sample from the individual; (b) analyzing said sample to obtain a first gene expression profile; (c) comparing said first gene expression 10769917 1 n(X'.

profile to a platinum chemotherapy responsivity predictor set of gene expression profiles to identify whether said individual will be responsive to a platinum-based therapy; (d) if said individual is a complete responder or incomplete responder, then administering an effective amount of platinum-based therapy to the individual; (e) if said individual is predicted to be an incomplete responder to platinum based therapy, then comparing the first gene expression profile to a set of gene expression profiles comprising at least 5 genes from Table I that is predictive of responsivity to additional cancer therapeutics to identify to which additional cancer therapeutic the individual would be responsive; and (f) administering to said individual an effective amount of one or more of the additional cancer therapeutic that was identified in step (e); thereby treating the individual with ovarian cancer.

[0008] In certain embodiments, the cellular sample is taken from a tumor sample or ascites.
In certain embodiments the set of gene expression profiles that is capable of predicting responsiveness to salvage therapy agents comprises at least 10 or 15 genes from Table 1. The cancer therapy agent may be a salvage therapy agent. In addition, the salvage therapy agent may be selected from the group consisting of topotecan, adriamycin, doxorubicin, cytoxan, cyclophosphamide, gemcitabine, etoposide, ifosfamide, paclitaxel, docetaxel, and taxol.
Furthermore, the cancer therapy agent may target a signal transduction pathway that is deregulated. The cancer therapy agent may be selected from the group consisting of inhibitors of the Src pathway, inhibitors of the E2F3 pathway, inhibitors of the Myc pathway, and inhibitors of the beta-catenin pathway. In one embodiment, the platinum-based therapy is administered first, followed by the administration of one or more salvage therapy agent. The platinum-based therapy may also be administered concurrently with one or more salvage therapy agent. One or more salvage therapy agent may be administered by itself.
Alternatively, the salvage therapy agent may be administered first, followed by the administration of one or more platinum-based therapy.

[00091 In yet another aspect, the invention provides for a gene chip for predicting an individual's responsivity to a salvage therapy agent comprising the gene expression profile of at least 5 genes selected from Table 1.

[0010] In yet another aspect, the invention provides for a gene chip for predicting an individual's responsivity to a salvage therapy agent comprising the gene expression profile of at least 10 genes selected from Table 1.

im~mi~ i nnr [0011] In yet another aspect, the invention provides for a gene chip for predicting an individual's responsivity to a salvage therapy agent comprising the gene expression profile of at least 20 genes selected from Table 1.

[0012] In yet another aspect, the invention provides for a kit comprising a gene chip for predicting an individual's responsivity to a salvage therapy agent and a set of instructions for determining an individual's responsivity to salvage chemotherapy agents.

[0013] In yet another aspect, the invention provides for a computer readable medium comprising gene expression profiles comprising at least 5 genes from any of Table 1.
[0014] In yet another aspect, the invention provides for a computer readable medium comprising gene expression profiles comprising at least 15 genes from Table 5.

[0015] In yet another aspect, the invention provides for a computer readable medium comprising gene expression profiles comprising at least 25 genes from Table 5.

[0016] In yet another aspect, the invention provides a method for estimating or predicting the efficacy of a therapeutic agent in treating an individual afflicted with cancer. In one aspect, the method comprises: (a) determining the expression level of multiple genes in a tumor biopsy sample from the subject; (b) defining the value of one or more metagenes from the expression levels of step (a), wherein each metagene is defined by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to the therapeutic agent; and (c) averaging the predictions of one or more statistical tree models applied to the values of the metagenes, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of tumor sensitivity to the therapeutic agent, wherein at least one of the metagenes comprises at least 3 genes in metagenes 1, 2, 3, 4, 5, 6, or 7, thereby estimating the efficacy of a therapeutic agent in an individual afflicted with cancer. In certain embodiments, step (a) comprises extracting a nucleic acid sample from the sample from the subject. In certain embodiments, the method further comprising: (d) detecting the presence of pathway deregulation by comparing the expression levels of the genes to one or more reference profiles indicative of pathway deregulation, and (e) selecting an agent that is predicted to be effective and regulates a pathway I n7AQ') 17 i nnr deregulated in the tumor. In certain embodiments said pathway is selected from RAS, SRC, MYC, E2F, and j3-catenin pathways.

[0017] In yet another aspect, the invention provides a method for estimating the efficacy of a therapeutic agent in treating an individual afflicted with cancer. In one aspect, the method comprises (a) determining the expression level of multiple genes in a tumor biopsy sample from the subject; (b) defining the value of one or more metagenes from the expression levels of step (a), wherein each metagene is defined by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to the therapeutic agent; and (c) averaging the predictions of one or more binary regression models applied to the values of the metagenes, wherein each model includes a statistical predictive probability of tumor sensitivity to the therapeutic agent, wherein at least one of the metagenes comprises at least 3 genes in metagene 1, 2, 3, 4, 5, 6, or 7, thereby estimating the efficacy of a therapeutic agent in an individual afflicted with cancer.

[0018] In yet another aspect, the invention provides a method of treating an individual afflicted with cancer, said method comprising: (a) estimating the efficacy of a plurality of therapeutic agents in treating an individual afflicted with cancer according to the methods if the invention; (b) selecting a therapeutic agent having the high estimated efficacy; and (c) administering to the subject an effective amount of the selected therapeutic agent, thereby treating the subject afflicted with cancer. The method of estimating the efficacy may comprise (i) determining the expression level of multiple genes in a tumor biopsy sample from the subject and (ii) averaging the predictions of one or more statistical tree models applied to the values of one or more of metagenes 1, 2, 3, 4, 5, 6, and 7, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of tumor sensitivity to the therapeutic agent.

[0019] In yet another aspect, the invention provides a therapeutic agent having the high estimated efficacy is one having an estimated efficacy in treating the subject of at least 50%. In certain embodiments, the invention provides a therapeutic agent having the high estimated efficacy is one having an estimated efficacy in treating the subject of at least 80%.

[0020] In certain embodiments, the tumor is selected from a breast tumor, an ovarian tumor, and a lung tumor. In certain embodiments, the therapeutic agent is selected from docetaxel, ( 10769217 I . DOC

paclitaxel, topotecan, adriamycin, etoposide, fluorouracil (5-FU), and cyclophosphamide, or any combination thereof.

[0021] In certain embodiments, the therapeutic agent is docetaxel and wherein the cluster of genes comprises at least 10 genes from metagene 1. In certain embodiments, the therapeutic agent is paclitaxel, and wherein the cluster of genes comprises at least 10 genes from metagene 2. In certain embodiments, wherein the therapeutic agent is topotecan, and wherein the cluster of genes comprises at least 10 genes from metagene 3. In certain embodiments, wherein the therapeutic agent is adriamycin, and wherein the cluster of genes comprises at least 10 genes from metagene 4. In certain embodiments, wherein the therapeutic agent is etoposide, and wherein the cluster of genes comprises at least 10 genes from metagene 5. In certain embodiments, wherein the therapeutic agent is fluorouracil (5-FU), and wherein the cluster of genes comprises at least 10 genes from metagene 6. In certain embodiments, wherein the therapeutic agent is cyclophosphamide and wherein the cluster of genes comprises at least 10 genes from metagene 7.

[0022] In certain embodiments, at least one of the metagenes is metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes corresponding to at least one of the metagenes comprises 3 or more genes in common to metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes corresponding to at least one metagene comprises 5 or more genes in common to metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes corresponding to at least one metagene comprises at least 10 genes, wherein half or more of the genes are common to metagene 1, 2, 3, 4, 5, 6, or 7.

[0023] In certain embodiments, each cluster of genes comprises at least 3 genes. In certain embodiments, each cluster of genes comprises at least 5 genes. In certain embodiments, each cluster of genes comprises at least 7 genes. In certain embodiments, each cluster of genes comprises at least 10 genes. In certain embodiments, each cluster of genes comprises at least 12 genes. In certain embodiments, each cluster of genes comprises at least 15 genes. In certain embodiments, each cluster of genes comprises at least 20 genes.

[00241 In certain embodiments, a nucleic acid sample is extracted from a subject. In certain embodiments, the expression level of multiple genes in the tumor biopsy sample is determined by quantitating nucleic acids levels of the multiple genes using a DNA
microarray.

10769') 17 1 nn(' [0025] In certain embodiments, at least one of the metagenes shares at least 3 of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, at least one of the metagenes shares at least 50% of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, at least one of the metagenes shares at least 75%
of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, at least one of the metagenes shares at least 90% of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, at least one of the metagenes shares at least 95%
of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, at least one of the metagenes shares at least 98% of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7.

[0026] In certain embodiments, the cluster of genes for at least two of the metagenes share at least 50% of their genes in common with one of metagenes 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes for at least two of the metagenes share at least 75% of their genes in common with one of metagenes 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes for at least two of the metagenes share at least 90% of their genes in common with one of metagenes 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes for at least two of the metagenes share at least 95% of their genes in common with one of metagenes 1, 2, 3, 4, 5, 6, or 7. In certain embodiments, the cluster of genes for at least two of the metagenes share at least 98% of their genes in common with one of metagenes 1, 2, 3, 4, 5, 6, or 7.

[0027] In certain embodiments, the cluster of genes comprises at least 3 genes. In certain embodiments, the cluster of genes comprises at least 5 genes. In certain embodiments, the cluster of genes comprises at least 10 genes. In certain embodiments, the cluster of genes comprises at least 15 genes. In certain embodiments, the correlation-based clustering is Markov chain correlation-based clustering or K-means clustering.

BRIEF DESCRIPTION OF THE DRAWINGS

[0028] The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

[0029] Figures 1 A-1 E show a gene expression signature that predicts sensitivity to docetaxel. (A) Strategy for generation of the chemotherapeutic response predictor. (B) Top panel - Cell lines from the NCI-60 panel used to develop the in vitro signature of docetaxel sensitivity. The figure shows a statistically significant difference (Mann Whitney U test of significance) in the IC50/GI50 and LC50 of the cell lines chosen to represent the sensitive and resistant subsets. Bottom Panel - Expression plots for genes selected for discriminating the docetaxel resistant and sensitive NCI-60 cell lines, depicted by color coding with blue representing the lowest level and red the highest. Each column in the figure represents individual samples. Each row represents an individual gene, ordered from top to bottom according to regression coefficients. (C) Top Panel - Validation of the docetaxel response prediction model in an independent set of lung and ovarian cancer cell line samples. A
collection of lung and ovarian cell lines were used in a cell proliferation assay to determine the 50% inhibitory concentration (IC50) of docetaxel in the individual cell lines.
A linear regression analysis demonstrates a statistically significant (p < 0.01, log rank) relationship between the ICso of docetaxel and the predicted probability of sensitivity to docetaxel. Bottom panel - Validation of the docetaxel response prediction model in another independent set of 29 lung cancer cell line samples (Gemma A, Geo accession number: GSE 4127). A linear regression analysis demonstrates a very significant (p < 0.001, log rank) relationship between the IC50 of docetaxel and the predicted probability of sensitivity to docetaxel. (D) Left Panel - A
strategy for assessment of the docetaxel response predictor as a function of clinical response in the breast neoadjuvant setting. Middle panel - Predicted probability of docetaxel sensitivity in a collection of samples from a breast cancer single agent neoadjuvant study. Twenty of twenty four samples (91.6%) were predicted accurately using the cell line based predictor of response to docetaxel.
Right panel - A single variable scatter plot demonstrating a significance test of the predicted probabilities of sensitivity to docetaxel in the sensitive and resistant tumors (p < 0.001, Mann Whitney U test of significance). (E) Left Panel - A strategy for assessment of the docetaxel response predictor as a function of clinical response in advanced ovarian cancer. Middle panel -Predicted probability of docetaxel sensitivity in a collection of samples from a prospective single agent salvage therapy study. Twelve of fourteen samples (85.7%) were predicted accurately using the cell line based predictor of response to docetaxel. Right panel - A
single variable scatter plot demonstrating statistical significance (p < 0.01, Mann Whitney U
test of significance).

~. .
[0030) Figures 2A-2C show the development of a panel of gene expression signatures that predict sensitivity to chemotherapeutic drugs. (A) Gene expression patterns selected for predicting response to the indicated drugs. The genes involved the individual predictors are shown in Table 1. (B) Independent validation of the chemotherapy response predictors in an independent set of cancer cell lines37 that have dose response and Affymetrix expression data.38 A single variable scatter plot demonstrating a significance test of the predicted probabilities of sensitivity to any given drug in the sensitive and resistant cell lines (p value, Mann Whitney U
test of significance). Red symbols indicate resistant cell lines, and blue symbols indicate those that are sensitive. (C) Prediction of single agent therapy response in patient samples using in vitro cell line based expression signatures of chemosensitivity. In each case, red represents non-responders (resistance) and blue represents responders (sensitivity). The left panel shows the predicted probability of sensitivity to topotecan when compared to actual clinical response data (n = 48), the middle panel demonstrates the accuracy of the adriamycin predictor in a cohort of 122 samples (Evans W, GSE650 and GSE651). The right panel shows the predictive accuracy of the cell line based paclitaxel predictor when used as a salvage chemotherapy in advanced ovarian cancer (n = 35). The positive and negative predictive values for all the predictors are summarized in Table 2.

[00311 Figures 3A-3B show the prediction of response to combination therapy.
(A) Left ,=
Panel - Strategy for assessment of chemotherapy response predictors in combination therapy as a function of pathologic response. Middle panel - Prediction of patient response to neoadjuvant chemotherapy involving paclitaxel, 5-flourouracil (5-FU), adriamycin, and cyclophosphamide (TFAC) using the single agent in vitro chemosensitivity signatures developed for each of these i drugs. Right Panel - Prediction of response (38 non-responders, 13 responders) emploYng a employing combined probability predictor assessing the probability of all four chemosensitivity signatures in 51 patients treated with TFAC chemotherapy shows statistical significance (p < 0.0001, Mann Whitney) between responders (blue) and non-responders (red). Response was defined as a complete pathologic response after completion of TFAC neoadjuvant therapy. (B) Left Panel -Prediction of patient response (n = 45) to adjuvant chemotherapy involving 5-FU, adriamycin, and cyclophosphamide (FAC) using the single agent in vitro chemosensitivity predictors I=
developed for these drugs. Middle panel - Prediction of response (34 responders, 11 non responders) employing a combined probability predictor assessing the probability of all four chemosensitivity signatures in 45 patients treated with FAC chemotherapy.
Right panel -

9 1(1760 17 1 Tlnr Kaplan Meier survival analysis for patients predicted to be sensitive (blue curve) or resistant (red curve) to FAC adjuvant chemotherapy.

[0032] Figure 4 shows patterns of predicted sensitivity to common chemotherapeutic drugs in human cancers. Hierarchical clustering of a collection of breast (n = 171), lung cancer (n =
91) and ovarian cancer (n = 119) samples according to patterns of predicted sensitivity to the various chemotherapeutics. These predictions were then plotted as a heatmap in which high probability of sensitivity /response is indicated by red, and low probability or resistance is indicated by blue.

100331 Figures 5A-5B show the relationship between predicted chemotherapeutic sensitivity and oncogenic pathway deregulation. (A) Left Panel - Probability of oncogenic pathway deregulation as a function of predicted docetaxel sensitivity in a series of lung cancer cell lines (red = sensitive, blue = resistant). Right panel - Probability of oncogenic pathway deregulation as a function of predicted topotecan sensitivity in a series of ovarian cancer cell lines (red =
sensitive, blue = resistant). (B) Left Panel - The lung cancer cell lines showing an increased probability of P13 kinase were also more likely to respond to a P13 kinase inhibitor (LY-294002) (p = 0.001, log-rank test)), as measured by sensitivity to the drug in assays of cell proliferation.
Further, those cell lines predicted to be resistant to docetaxel were more likely to be sensitive to P13 kinase inhibition (p < 0.001, log-rant test) Right panel - The relationship between Src pathway deregulation and topotecan resistance can be demonstrated in a set of 13 ovarian cancer cell lines. Ovarian cell lines that are predicted to be topotecan resistant have a higher likelihood of Src pathway deregulation and there is a significant linear relationship (p = 0.001, log rank) between the probability of topotecan resistance and sensitivity to a drug that inhibits the Src pathway (SU6656).

[0034] Figure 6 shows a scheme for utilization of chemotherapeutic and oncogenic pathway predictors for identification of individualized therapeutic options.

100351 Figures 7A-7C show a patient-derived docetaxel gene expression signature predicts response to docetaxel in cancer cell lines. (A) Top panel - A ROC curve analysis to show the approach used to define a cut-off, using docetaxel as an example. Middle panel - A t-test plot of significance between the probability of docetaxel sensitivity and IC 50 for docetaxel sensitive in cell lines, shown by histologic type. Bottom panel - A linear regression analysis showing the im( mi'7 1 nnr significant correlation between predicted intro sensitivity and actual sensitivity (IC50 for docetaxel), in lung and ovarian cancer cell lines. (B) Generation of a docetaxel response predictor based on patient data that was then validated in a leave on out cross validation and .
linear regression analyses (p-value obtained by log-rank), evaluated against the IC50 for docetaxel in two NCI-60 cell line drug screening experiments. (C) A comparison of predictive accuracies between a predictor for docetaxel generated from the cell line data (left panel, accuracy: 85.7%) and a predictor generated from patients treatment data (right panel, accuracy:
64.3%) shows the relative inferiority of the latter approach, when applied to an independent dataset of ovarian cancer patients treated with single agent docetaxel.

[0036] Figures 8A-8C show the development of gene expression signatures that predict sensitivity to a panel of commonly used chemotherapeutic drugs. Panel A shows the gene expression models selected for predicting response to the indicated drugs, with resistant lines on the left, sensitive on the right for each predictor. Panel B shows the leave one out cross validation accuracy of the individual predictors. Panel C demonstrates the results of an independent validation of the chemotherapy response predictors in an independent set of cancer cell lines37 shown as a plot with error bars (blue- sensitive, red -resistant).

[0037] Figure 9 shows the specificity of chemotherapy response predictors. In each case, individual predictors of response to the various cytotoxic drugs was plotted against cell lines known to be sensitive or sensitive to a given chemotherapeutic agent (e.g., adriamycin, paclitaxel).

[0038] Figure 10 shows the absolute probabilities of response to various chemotherapies in human lung and breast cancer samples.

[0039] Figures 11 A-11 C show the relationships in predicted probability of response to chemotherapies in breast (Panel A), lung (Panel B) and ovarian cancer (Panel C). In each case, a regression analysis (log rank) of predicted probability of response of two drugs is shown.

[0040] Figure 12 shows a gene expression based signature of P13 kinase pathway deregulation. Image intensity display of expression levels for genes that most differentiate control cells expressing GFP from cells expressing the oncogenic activity of P13 kinase. The expression value of genes composing each signature is indicated by color, with blue representing i muw) ry i nnr the lowest value and red representing the highest level. The panel below shows the results of a leave one out cross validation showing a reliable differentiation between GFP
controls (blue) and cells expressing P13 kinase (red).

[0041] Figures 13A-13C show the relationship between oncogenic pathway deregulation and chemosensitivity patterns (using docetaxel as an example). (A) Probability of oncogenic pathway deregulation as a function of predicted docetaxel sensitivity in the NCI-60 cell line panel (red = sensitive, blue = resistant). (B) Linear regression analysis (log-rank test of significance) to identify relationships between predicted docetaxel sensitivity or resistance and deregulation of P13 kinase, E2F3, and Src pathways. (C) A non-parametric t-test of significance demonstrating a significant difference in docetaxel sensitivity, between those cell lines predicted to be either pathway deregulated (>50% probability, red) or quiescent (<50%
probability, blue), shown for both E2F and P13 kinase pathways.

[0042] Figure 14 shows a scatter plot showing a linear regression analysis that identifies a statistically significant correlation between probability of docetaxel resistance and P13 Kinase pathway activation in an independent cohort of 17 non-small cell lung cancer cell lines.

[0043] Figure 15 shows a functional block diagram of general purpose computer system 1500 for performing the functions of the software provided by the invention.

BRIEF DESCRIPTION OF THE TABLES

[0044] Table 1 lists the predictor set for commonly used chemotherapeutics.

[0045] Table 2 is a summary of the chemotherapy response predictors -validations in cell line and patient data sets.

[0046] Table 3 shows an enrichment analysis shows that a genomic-guided response prediction increases the probability of a clinical response in the different data sets studied.
[00471 Table 4 shows the accuracy of genomic-based chemotherapy response predictors is compared to previously reported predictors of response.

[0048] Table 5 lists the genes that constitute the predictor of P13 kinase activation.

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DETAILED DESCRIPTION OF THE INVENTION

[0049] An individual who has cancer frequently has progressed to an advanced stage before any symptoms appear. The difficulty with administering one or more chemotherapeutic agents is that not all individuals with cancer will respond favorably to the chemotherapeutic agent selected by the physician. Frequently, the administration of one or more chemotherapeutic ~..
agents results in the individual becoming even more ill from the toxicity of the agent and the !
cancer still persists. Due to the cytotoxic nature of chemotherapeutic agents, the individual is physically weakened and his/her immunologically compromised system cannot generally tolerate multiple rounds of "trial and error" type of therapy. Hence a treatment plan that is personalized for the individual is highly desirable.

[0050] The inventors have described gene expression profiles associated with determining whether an individual afflicted with cancer will respond to a therapy, and in particular to a therapeutic agents such as salvage agents. This analysis has been coupled with gene expression signatures that reflect the deregulation of various oncogenic signaling pathways to identify unique characteristics of chemotherapeutic resistant cancers that can guide the use of these drugs in patients with chemotherapeutic resistant disease. The invention thus provides integrating gene expression profiles that predict chemotherapeutic response and oncogenic pathway status as a strategy for developing personalized treatment plans for individual patients.

Definitions [0051] "Platinum-based therapy" and "platinum-based chemotherapy" are used interchangeably herein and refers to agents or compounds that are associated with platinum.
[0052] As used herein, "array" and "microarray" are interchangeable and refer to an arrangement of a collection of nucleotide sequences in a centralized location.
Arrays can be on a solid substrate, such as a glass slide, or on a semi-solid substrate, such as nitrocellulose ,.
membrane. The nucleotide sequences can be DNA, RNA, or any permutations thereof. The nucleotide sequences can also be partial sequences from a gene, primers, whole gene sequences, non-coding sequences, coding sequences, published sequences, known sequences, or novel sequences.

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[0053] A "complete response" (CR) is defined as a complete disappearance of all measurable and assessable disease or, in the absence of measurable lesions, a normalization of the CA-125 level following adjuvant therapy. An individual who exhibits a complete response is known as a "complete responder."

[0054] An "incomplete response" (IR) includes those who exhibited a "partial response"
(PR), had "stable disease" (SD), or demonstrated "progressive disease" (PD) during primary therapy.

[0055] A "partial response" refers to a response that displays 50% or greater reduction in the product obtained from measurement of each bi-dimensional lesion for at least 4 weeks or a drop in the CA-125 by at least 50% for at least 4 weeks.

[00561 "Progressive disease" refers to response that is a 50% or greater increase in the product from any lesion documented within 8 weeks of initiation of therapy, the appearance of any new lesion within 8 weeks of initiation of therapy, or any increase in the CA-125 from baseline at initiation of therapy.

[0057] "Stable disease" was defined as disease not meeting any of the above criteria.

[0058] "Effective amount" refers to an amount of a chemotherapeutic agent that is sufficient to exert a biological effect in the individual. In most cases, an effective amount has been established by several rounds of testing for submission to the FDA. It is desirable for an effective amount to be an amount sufficient to exert cytotoxic effects on cancerous cells.

[00591 "Predicting" and "prediction" as used herein does not mean that the event will happen with 100% certainty. Instead it is intended to mean the event will more likely than not happen.

[00601 As used herein, "individual" and "subject" are interchangeable. A
"patient" refers to an "individual" who is under the care of a treating physician. In one embodiment, the subject is a male. In one embodiment, the subject is a female.

im~mi~ ~ nnr General Techniques [0100] The practice of the present invention will employ, unless otherwise indicated, conventional techniques of molecular biology (including recombinant techniques), microbiology, cell biology, biochemistry, nucleic acid chemistry, and immunology, which are well known to those skilled in the art. Such techniques are explained fully in the literature, such as, Molecular Cloning: A Laboratory Manual, second edition (Sambrook et al., 1989) and Molecular Cloning: A Laboratory Manual, third edition (Sambrook and Russel, 2001), (jointly referred to herein as "Sambrook"); Current Protocols in Molecular Biology (F.M. Ausubel et al., eds., 1987, including supplements through 2001); PCR: The Polymerase Chain Reaction, (Mullis et al., eds., 1994); Harlow and Lane (1988) Antibodies, A Laboratory Manual, Cold Spring Harbor Publications, New York; Harlow and Lane (1999) Using Antibodies:
A
Laboratory Manual Cold Spring Harbor Laboratory Press, Cold Spring Harbor, NY
(jointly referred to herein as "Harlow and Lane"), Beaucage et al. eds., Current Protocols in Nucleic Acid Chemistry John Wiley & Sons, Inc., New York, 2000) and Casarett and Doull's Toxicology The Basic Science ofPoisons, C. Klaassen, ed., 6th edition (2001).

Methods of Predicting Responsivity to Salvage Agents [0101] Gene expression profiles may be obtained from tumor samples taken during surgery to debulk individuals with ovarian cancer. It is also possible to generate a predictor set for predicting responsivity to common chemotherapy agents by using publicly available data.
Numerous websites exist that share data obtained from microarray analysis. In one embodiment, gene expression profiling data obtained from analysis of 60 cancerous cells lines, known herein as NCI-60, can be used to generate a training set for predicting responsivity to cancer therapy agents. The NCI-60 training set can be validated by the same type of "Leave-one-out" cross-validation as described earlier.

[0102] The predictor sets for the other salvage therapy agents are shown in Table 1. The genes listed in Table 1 represent, to the best of Applicants' knowledge, a novel gene predictor set. The genes in the predictor set would not have been obvious to one of ordinary skill in the art. These predictor sets are used as a reference set to compare the first gene expression profile from an individual with ovarian cancer to determine if she will be responsive to a particular ~
15 !
imAmi7 i nnr salvage agent. In certain embodiments, the methods of the application are performed outside of the human body.

Method of TreatingIndividuals with Ovarian Cancer [0103] This methods described herein also include treating an individual afflicted with ovarian cancer. In the instance where the individual is predicted to be a non-responder to platinum-based therapy, a physician may decide to administer salvage therapy agent alone. In most instances, the treatment will comprise a combination of a platinum-based therapy and a salvage agent. In one embodiment, the treatment will comprise a combination of a platinum-based therapy and an inhibitor of a signal transduction pathway that is deregulated in the individual with ovarian cancer.

[0104] In one embodiment, the platinum-based therapy and a salvage agent are administered in an effective amount concurrently. In another embodiment, the platinum-based therapy and a salvage agent are administered in an effective amount in a sequential manner.
In yet another embodiment, the salvage therapy agent is administered in an effective amount by itself. In yet another embodiment, the salvage therapy agent is administered in an effective amount first and then followed concurrently or step-wise by a platinum-based therapy.

Methods of Predicting /Estimating the Efficacy of a Therapeutic Agent in Treatinga Individual Afflicted with Cancer [0105] One aspect of the invention provides a method for predicting, estimating, aiding in the prediction of, or aiding in the estimation of, the efficacy of a therapeutic agent in treating a subject afflicted with cancer. In certain embodiments, the methods of the application are performed outside of the human body.

[0106] One method comprises (a) determining the expression level of multiple genes in a tumor biopsy sample from the subject; (b) defining the value of one or more metagenes from the expression levels of step (a), wherein each metagene is defined by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to the therapeutic agent; and (c) averaging the predictions of one or more statistical tree models applied to the values of the metagenes, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical predictive 107697~7 ~ tlnr probability of tumor sensitivity to the therapeutic agent, wherein at least one of the metagenes comprises at least 3 genes in metagenes 1, 2, 3, 4, 5, 6, or 7, thereby estimating the efficacy of a therapeutic agent in a subject afflicted with cancer. Another method comprises (a) determining the expression level of multiple genes in a tumor biopsy sample from the subject; (b) defining the value of one or more metagenes from the expression levels of step (a), wherein each metagene is defined by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to the therapeutic agent; and (c) averaging the predictions of one or more binary regression models applied to the values of the metagenes, wherein each model includes a statistical predictive probability of tumor sensitivity to the therapeutic agent, wherein at least one of the metagenes comprises at least 3 genes in metagenes 1, 2, 3, 4, 5, 6, or 7, thereby estimating the efficacy of a therapeutic agent in a subject afflicted with cancer.

[0107] In one embodiment, the predictive methods of the invention predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 70% accuracy. In another embodiment, the methods predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 80% accuracy. In another embodiment, the methods predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 85%
accuracy. In another embodiment, the methods predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 90% accuracy. In another embodiment, the methods predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 70%, 80%, 85% or 90% accuracy when tested against a validation sample. In another embodiment, the methods predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 70%, 80%, 85% or 90% accuracy when tested against a set of training samples. In another embodiment, the methods predict the efficacy of a therapeutic agent in treating a subject afflicted with cancer with at least 70%, 80%, 85% or 90%
accuracy when tested on human primary tumors ex vivo or in vivo.

(A) Tumor Sample 101081 In one embodiment, the predictive methods of the invention comprise determining the expression level of genes in a tumor sample from the subject, preferably a breast tumor, an -ovarian tumor, and a lung tumor. In one embodiment, the tumor is not a breast tumor. In one embodiment, the tumor is not an ovarian tumor. In one embodiment, the tumor is not a lung 1 n7Fwr7 i nnr tumor. In one embodiment of the methods described herein, the methods comprise the step of surgically removing a tumor sample from the subject, obtaining a tumor sample from the subject, or providing a tumor sample from the subject. In one embodiment, the sample contains at least 40%, 50%, 60%, 70%, 80% or 90% tumor cells. In preferred embodiments, samples having greater than 50% tumor cell content are used. In one embodiment, the tumor sample is a live tumor sample. In another embodiment, the tumor sample is a frozen sample.
In one embodiment, the sample is one that was frozen within less than 5, 4, 3, 2, 1, 0.75, 0.5, 0.25, 0.1, 0.05 or less hours after extraction from the patient. Preferred frozen sample include those stored in liquid nitrogen or at a temperature of about -80C or below.

(B) Gene Expression [0109] The expression of the genes may be determined using any methods known in the art for assaying gene expression. Gene expression may be determined by measuring mRNA or protein levels for the genes. In a preferred embodiment, an mRNA transcript of a gene may be detected for determining the expression level of the gene. Based on the sequence information provided by the GenBankTM database entries, the genes can be detected and expression levels measured using techniques well known to one of ordinary skill in the art. For example, sequences within the sequence database entries corresponding to polynucleotides of the genes can be used to construct probes for detecting mRNAs by, e.g., Northern blot hybridization analyses. The hybridization of the probe to a gene transcript in a subject biological sample can be also carried out on a DNA array. The use of an array is preferable for detecting the expression level of a plurality of the genes. As another example, the sequences can be used to construct primers for specifically amplifying the polynucleotides in, e.g., amplification-based detection methods such as reverse-transcription based polymerase chain reaction (RT-PCR). Furthermore, the expression level of the genes can be analyzed based on the biological activity or quantity of proteins encoded by the genes.

[0110] Methods for determining the quantity of the protein includes immunoassay methods.
Paragraphs 98-123 of U.S. Patent Pub No. 2006-0110753 provide exemplary methods for determining gene expression. Additional technology is described in U.S. Pat.
Nos. 5,143,854;
5,288,644; 5,324,633; 5,432,049; 5,470,710; 5,492,806; 5,503,980; 5,510,270;
5,525,464;
5,547,839; 5,580,732; 5,661,028; 5,800,992; as well as WO 95/21265; WO
96/31622; WO
97/10365; WO 97/27317; EP 373 203; and EP 785 280.

i n'7aQ? 17 1 nnr [0111] In one exemplary embodiment, about 1-50mg of cancer tissue is added to a chilled tissue pulverizer, such as to a BioPulverizer H tube (Bio101 Systems, Carlsbad, CA). Lysis buffer, such as from the Qiagen Rneasy Mini kit, is added to the tissue and homogenized.
Devices such as a Mini-Beadbeater (Biospec Products, Bartlesville, OK) may be used. Tubes may be spun briefly as needed to pellet the garnet mixture and reduce foam.
The resulting lysate may be passed through syringes, such as a 21 gauge needle, to shear DNA. Total RNA may be extracted using commercially available kits, such as the Qagen RNeasY Mini kit. The samples Qiagen may be prepared and arrayed using Affymetrix U133 plus 2.0 GeneChips or Affymetrix U133A

GeneChips.
[0112] In one embodiment, determining the expression level of multiple genes in a tumor sample from the subject comprises extracting a nucleic acid sample from the sample from the subject, preferably an mRNA sample. In one embodiment, the expression level of the nucleic acid is determined by hybridizing the nucleic acid, or amplification products thereof, to a DNA
microarray. Amplification products may be generated, for example, with reverse transcription, optionally followed by PCR amplification of the products.

(C) Genes Screened [0113] In one embodiment, the predictive methods of the invention comprise determining the expression level of all the genes in the cluster that define at least one therapeutic sensitivity/resistance determinative metagene. In one embodiment, the predictive methods of the invention comprise determining the expression level of at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes in each of the clusters that defines 1, 2, 3, 4 or 5 or more of metagenes 1, 2, 3, 4, 5, 6 and 7.

[0114] In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict 5-FU sensitivity (or the genes in the cluster that define a metagene having said predictivity) are genes represented by the following symbols: LOC92755 (TUBB, LOC648765), CDKN2A, TRA@, GABRA3, COL1A2, ACTB, PDLIM4, ACTA2, FTSJI, NBR1 (LOC727732), CFLI, ATP1A2, APOC4, KIAA1509, ZNF516, GRIK5, PDE5A, ARSF, ZC3H7B, WBP4, CSTB, TSPY1 (TSPY2, LOC653174, LOC728132, LOC728137, LOC728395, LOC728403, LOC728412), HTR2B, KBTBDI1, SLC25A17, HMGN3, FIBP, IFT140, FAM63B, ZNF337, KIAA0100, FAM13C1, STK25, ln"7/,Q) 17 1 nnr CPNE1, PEX19, EIF5B, EEFIAI (APOLDI, LOC440595), SRR, THEM2, ID4, GGT1 (GGTL4), IFNA10, TUBB2A (TUBB4, TUBB2B), and TUBB3.

[0115] In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict adriamycin sensitivity are genes represented by the following symbols: MLANA, CSPG4, DDR2, ETS2, EGFR, BIK, CD24, ZNF185, DSCRI, GSN, TPSTl, LCN2, FAIM3, NCK2, PDZRN3, FKBP2, KRT8, NRP2, PKP2, CLDN3, CAPN1, STXBPI, LY96, WWCl, ClOorf56, SPINT2, MAGED2, SYNGR2, SGCD, LAMC2, C19orf21, ZFHXIB, KRT18, CYBA, DSP, ID1, ID1, PSAP, ZNF629, ARHGAP29, ARHGAP8 (LOC553158), GPM6B, EGFR, CALU, KCNK1, RNF144, FEZ1, MEST, KLF5, CSPG4, FLNB, GYPC, SLC23A2, MITF, PITPNMI, GPNMB, PMP22, PLXNB3 (SRPK3), MIA, RAB40C, MAD2LIBP, PLOD3, VIL2, KLF9, PODXL, ATP6V1B2, SLC6A8, PLP1, KRT7, PKP3, DLG3, ZHX2, LAMA5, SASH1, GAS1, TACSTD1, GAS1, and CYP27AI.

[0116] In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict cytoxan sensitivity (or the genes in the cluster that define a metagene having said predictivity) are genes represented by the following symbols: DAP3, RPS9, TTR, ACTB, MARCKS, GGTI (GGT2), GGTL4, GGTLA4, LOC643171, LOC653590, LOC728226, LOC728441, LOC729838, LOC731629), FANCA, CDC42EP3, TSPAN4, C6orf145, ARNT2, KIF22 (LOC728037), NBEAL2, CAV1, SCRN1, SCHIPI, PHLDBI, AKAP12, ST5, SNAI2, ESD, ANP32B, CD59, ACTN1, CD59, PEG10, SMARCAI, GGCX, SAMD4A, CNN3, LPP, SNRPF, SGCE, CALDI, and C22orf5.

[0117] In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict docetaxel sensitivity (or the genes in the cluster that define a metagene having said predictivity) are genes represented by the following symbols: BLRI, EIF4A2, FLTI, BAD, PIP5K3, BIN1, YBX1, BCKDK, DOHH, FOXD1, TEX261, NBRI (LOC727732), APOA4, DDX5, TBCA, USP52, SLC25A36, CHP, ANKRD28, PDXK, ATP6API, SETD2, CCS, BRD2, ASPHDI, B4GALT6, ASL, CAPZA2, STARD3, LIMK2 (PPP1R14BP1), BANF1, GNB2, ENSA, SH3GL1, ACVRIB, SLC6A1, PPP2RIA, PCGF1, LOC643641, INPP5A, TLE1, PLLP, ZKSCANI, TIAL1, TK1, PPP2RIA, and PSMB6.

imAcni, I rinr [01181 In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict etoposide sensitivity are genes represented by the following symbols: LIMK1, LIG3, AXL, IFI16, MMP14, GRB7, VAV2, FLT1, JUP, FN1, FNI, PKM2, LYPLA3, RFTN1, LAD1, SPINTI, CLDN3, PTRF, SPINT2, MMP14, FAAH, CLDN4, ST14, C19orf21, KIAA0506, LLGL2 (MADD), COBL, ZFHXIB, GBP1, IER2, PPL, TMEM30B, CNKSRI, CLDN7, BTN3A2, BTN3A2, TUBB2A, MAP7, HNRNPG-T, UGCG, GAK, PKP3, DFNA5, DAB2, TACSTD1, SPARC, and PPP2R5A.
[0119] In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict taxol sensitivity (or the genes in the cluster that define a metagene having said predictivity) are genes represented by the following symbols: NR2F6, TOP2B, RARG, PCNA, PTPN11, ATM, NFATC4, CACNG1, C22orf31, PIK3R2, PRSS12, MYH8, SCCPDH, PHTF2, IQSEC2, TRPC3, TRAFDI, HEPH, SOX30, GATM, LMNA, HD, YIPF3, DNPEP, PCDH9, KLHDC3, SLC10A3, LHX2, CKS2, SECTMI, SF1, RPS6KA4, DYRK2, GDI2, and IFI30.

101201 In one embodiment, at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes whose expression levels are determined to predict topotecan sensitivity (or the genes in the cluster that define a metagene having said predictivity) are genes represented by the following symbols: DUSP1, THBS1, AXL, RAPIGAP, QSCN6, IL1R1, TGFBI, PTX3, BLM, TNFRSFIA, FGF2, VEGFC, ACO2, FARSLA, RIN2, FGF2, RRAS, FIGF, MYB, CDH2, FGFR1, FGFR1, LAMCI, HISTIH4K (HISTIH4J), COL6A2, TMC6, PEA15, MARCKS, CKAP4, GJA1, FBN1, BASP1, BASP1, BTN2A1, ITGB1, DKFZP686A01247, MYLK, LOXL2, HEGI, DEGS1, CAP2, CAP2, PTGER4, BAI2, NUAK1, DLEUI (SPANXC), RAB 11 FIP5, FSTL3, MYL6, VIM, GNA12, PRAF2, PTRF, CCL2, PLOD2, COL6A2, ATP5G3, GSR, NDUFS3, ST14, NIDI, MYO1D, SDHB, CAVI, DPYSL3, PTRF, FBXL2, RIN2, PLEKHCl, CTGF, COL4A2, TPM1, TPM1, TPM1, FZD2, LOXL1, SYK, HADHA, TNFAIPI, NNMT, HPGD, MRC2, MEIS3P1, AOX1, SEMA3C, SEMA3C, SYNE1, SERPINEI, IL6, RRAS, GPDIL, AXL, WDR23, CLDN7, IL15, TNFAIP2, CYR61, LRP1, AMOTL2, PDE 1 B, SPOCK 1, RAI14, PXDN, COL4A 1, C 1 R, KIAA0802 (C21 orf57), C5orfl 3, ~=
TUFM, EDIL3, BDNF, PRSS23, ATP5A1> FRAT2, C16orf51> TUSC4, NUP50> TUBA3, NFIB, , TLE4, AKT3, CRIM1, RAD23A, COX5A, SMCR7L, MXRA7, STARD7, STC1, TTC28, PLK2, TGDS, CALD1, OPTN, IFITM3, DFNA5, FGFR1, HTATIP, SYK, LAMB1, FZD2, SERPINEI, THBS1, CCL2, ITGA3, ITGA3, and UBE2A.

[0121] Table 1 shows the genes in the cluster that define metagenes 1-7 and indicates the therapeutic agent whose sensitivity it predicts. In one embodiment, at least 3, 5, 7, 9, 10, 12, 14, 16, 18, 20, 25, 30, 40 or 50 genes in the cluster of genes defining a metagene used in the methods described herein are common to metagene 1, 2, 3, 4, 5, 6 or 7, or to combinations thereof.

(D) Metagene Valuation [0122] In one embodiment, the predictive methods of the invention comprise defining the value of one or more metagenes from the expression levels of the genes. A
metagene value is defined by extracting a single dominant value from a cluster of genes associated with sensitivity to an anti-cancer agent, preferably an anti-cancer agent such as docetaxel, paclitaxel, topotecan, adriamycin, etoposide, fluorouracil (5-FU), and cyclophosphamide. In one embodiment, the agent is selected from alkylating agents (e.g., nitrogen mustards), antimetabolites (e.g., pyrimidine analogs), radioactive isotopes (e.g., phosphorous and iodine), miscellaneous agents (e.g., substituted ureas) and natural products (e.g., vinca alkyloids and antibiotics). In another embodiment, the therapeutic agent is selected from the group consisting of allopurinol sodium, dolasetron mesylate, pamidronate disodium, etidronate, fluconazole, epoetin alfa, levamisole HCL, amifostine, granisetron HCL, leucovorin calcium, sargramostim, dronabinol, mesna, filgrastim, pilocarpine HCL, octreotide acetate, dexrazoxane, ondansetron HCL, ondansetron, busulfan, carboplatin, cisplatin, thiotepa, melphalan HCL, melphalan, cyclophosphamide, ifosfamide, chlorambucil, mechlorethamine HCL, carmustine, lomustine, polifeprosan 20 with carmustine implant, streptozocin, doxorubicin HCL, bleomycin sulfate, daunirubicin HCL, dactinomycin, daunorucbicin citrate, idarubicin HCL, plimycin, mitomycin, pentostatin, mitoxantrone, valrubicin, cytarabine, fludarabine phosphate, floxuridine, cladribine, methotrexate, mercaptipurine, thio anine, capecitabine, methyltestosterone, nilutamide, 1~
testolactone, bicalutamide, flutamide, anastrozole, toremifene citrate, estramustine phosphate sodium, ethinyl estradiol, estradiol, esterified estrogens, conjugated estrogens, leuprolide acetate, goserelin acetate, medroxyprogesterone acetate, megestrol acetate, levamisole HCL, aldesleukin, irinotecan HCL, dacarbazine, asparaginase, etoposide phosphate, gemcitabine HCL, altretamine, topotecan HCL, hydroxyurea, interferon alpha-2b, mitotane, procarbazine HCL, vinorelbine tartrate, E. coli L-asparaginase, Erwinia L-asparaginase, vincristine sulfate, denileukin diftitox, i,.
aldesleukin, rituximab, interferon alpha-2a, paclitaxel, docetaxel, BCG live (intravesical), vinblastine sulfate, etoposide, tretinoin, teniposide, porfimer sodium, fluorouracil, betamethasone sodium phosphate and betamethasone acetate, letrozole, etoposide citrororum factor, folinic acid, calcium leucouorin, 5-fluorouricil, adriamycin, cytoxan, and diamino-dichloro-platinum.

[0123] In a preferred embodiment, the dominant single value is obtained using single value decomposition (SVD). In one embodiment, the cluster of genes of each metagene or at least of one metagene comprises at least 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 18, 20 or 25 genes. In one embodiment, the predictive methods of the invention comprise defining the value of 2, 3, 4, 5, 6, 7, 8, 9 or 10 or more metagenes from the expression levels of the genes.

101241 In preferred embodiments of the methods described herein, at least 1, 2, 3, 4, 5, 6, 7, 8 or 9 of the metagenes is metagene 1, 2, 3, 4, 5, 6, or 7. In one embodiment, at least one of the metagenes comprises 3, 4, 5, 6, 7, 8, 9 or 10 or more genes in common with any one of metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, a metagene shares at least 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99% of the genes in its cluster in common with a metagene selected from 1,2,3,4,5,6,or7.

[0125] In one embodiment, the predictive methods of the invention comprise defining the value of 2, 3, 4, 5, 6, 7, 8 or more metagenes from the expression levels of the genes. In one embodiment, the cluster of genes from which any one metagene is defined comprises at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22 or 25 genes.

[0126] In one embodiment, the predictive methods of the invention comprise defining the value of at least one metagene wherein the genes in the cluster of genes from which the metagene is defined, shares at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of genes in common to any one of metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, the predictive methods of the invention comprise defining the value of at least two metagenes, wherein the genes in the cluster of genes from which each metagene is defined share at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of genes in common to anyone of metagenes 1, 2, 3, 4, 5, 6, or 7.
In one embodiment, the predictive methods of the invention comprise defining the value of at least three metagenes, wherein the genes in the cluster of genes from which each metagene is I mf Q71'1 1 nnr '- .

defined shares at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of genes in common to anyone of metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, the predictive methods of the invention comprise defining the value of at least four metagenes, wherein the genes in the cluster of genes from which each metagene is defined shares at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of genes in common to anyone of metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, the predictive methods of the invention comprise defining the value of at least five metagenes, wherein the genes in the cluster of genes from which each metagene is defined shares at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of genes in common to anyone of metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, the predictive methods of the invention comprise defining the value of a metagene from a cluster of genes, wherein at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 genes in the cluster are selected from the genes listed in Table 1.
[01271 In one embodiment, at least one of the metagenes is metagene 1, 2, 3, 4, 5, 6, or 7. In one embodiment, at least two of the metagenes are selected from metagenes 1, 2, 3, 4, 5, 6, or 7.
In one embodiment, at least three of the metagenes are selected from metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, at least three of the metagenes are selected from metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, at least four of the metagenes are selected from metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment, at least five or more of the metagenes are selected from metagenes 1, 2, 3, 4, 5, 6, or 7. In one embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 1 or (ii) shares at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 or 13 genes in common with metagene 1. In one embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 2 or (ii) shares at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 genes in common with metagene 2. In one embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 3 or (ii) shares at least 2, 3 or 4 genes in common with metagene 3. In one embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 4 or (ii) shares at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 or 25 genes in common with metagene 4. In one embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 5 or (ii) shares at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 genes in common with metagene 5. In one embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 6 or (ii) shares at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 or 13 genes in common with metagene 6. In one i m~a~ ~ ~ i nnr embodiment of the methods described herein, one of the metagenes whose value is defined (i) is metagene 7 or (ii) shares at least 2, 3, 4, 5, 6, 7, 8, 9 or 10 genes in common with metagene 7.
(E) Predictions from Tree Models [0128] In one embodiment, the predictive methods of the invention conVrisc averaging the predictions of one or more statistical tree models applied to the metagenes values, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of sensitivity to an anti-cancer agent. The statistical tree models may be generated using the methods described herein for the generation of tree models. General methods of generating tree models may also be found in the art (See for example Pitman et al., Biostatistics 2004;5:587-601; Denison et al. Biometrika 1999;85:363-77; Nevins et al. Hum Mol Genet 2003;12:R153-7; Huang et al. Lancet 2003;361:1590-6; West et al. Proc NatlAcad Sci USA 2001;98:11462-7; U.S. Patent Pub. Nos. 2003-0224383; 2004- 0083084; 2005-0170528;
2004- 0106113; and U.S. Application No. 11/198782).

[0129] In one embodiment, the predictive methods of the invention comprise deriving a prediction from a single statistical tree model, wherein the model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of sensitivity to an anti-cancer agent. In a preferred embodiment, the tree comprises at least 2 nodes. In a preferred embodiment, the tree comprises at least 3 nodes. In a preferred embodiment, the tree comprises at least 3 nodes. In a preferred embodiment, the tree comprises at least 4 nodes. In a preferred embodiment, the tree comprises at least 5 nodes.
~.-[0130] In one embodiment, the predictive methods of the invention comprise averaging the predictions of one or more statistical tree models applied to the metagenes values, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of sensitivity to an anti-cancer agent.
Accordingly, the invention provides methods that use mixed trees, where a tree may contain at least two nodes, where each node represents a metagene representative to the sensitivity/resistance to a particular agent.

[01311 In one embodiment, the statistical predictive probability is derived from a Bayesian analysis. In another embodiment, the Bayesian analysis includes a sequence of Bayes factor ,I .
based tests of association to rank and select predictors that define a node binary split, the binary split including a predictor/threshold pair. Bayesian analysis is an approach to statistical analysis }
that is based on the Bayes law, which states that the posterior probability of a parameter p is proportional to the prior probability of parameter p multiplied by the likelihood of p derived from the data collected. This methodology represents an alternative to the traditional (or ,. .
frequentist probability) approach: whereas the latter attempts to establish confidence intervals around parameters, and/or falsify a-priori null-hypotheses, the Bayesian approach attempts to keep track of how apriori expectations about some phenomenon of interest can be refined, and how observed data can be integrated with such a-priori beliefs, to arrive at updated posterior expectations about the phenomenon. Bayesian analysis have been applied to numerous statistical models to predict outcomes of events based on available data.
These include standard regression models, e.g. binary regression models, as well as to more complex models that are applicable to multi-variate and essentially non-linear data.

[0132] Another such model is commonly known as the tree model which is essentially based on a decision tree. Decision trees can be used in clarification, prediction and regression. A
decision tree model is built starting with a root mode, and training data partitioned to what are essentially the "children" nodes using a splitting rule. For instance, for clarification, training data contains sample vectors that have one or more measurement variables and one variable that determines that class of the sample. Various splitting rules may be used;
however, the success of the predictive ability varies considerably as data sets become larger.
Furthermore, past attempts at determining the best splitting for each mode is often based on a "purity"
function calculated from the data, where the data is considered pure when it contains data samples only from one clan. Most frequently, used purity functions are entropy, gini-index, and towing rule. A
statistical predictive tree model to which Bayesian analysis is applied may consistently deliver accurate results with high predictive capabilities.

[0133] Gene expression signatures that reflect the activity of a given pathway may be identified using supervised classification methods of analysis previously described (e.g., West, M. et al. Proc Natl Acad Sci USA 98, 1 1 462-1 1 467, 2001). The analysis selects a set of genes whose expression levels are most highly correlated with the classification of tumor samples into sensitivity to an anti-cancer agent versus no sensitivity to an anti-cancer agent. The dominant principal components from such a set of genes then defines a relevant phenotype-related i m~4~ i~ i nnr metagene, and regression models assign the relative probability of sensitivity to an anti-cancer ~..
agent.

[0134] In one embodiment, the methods for defining one or more statistical tree models predictive of cancer sensitivity to an anti-cancer agent comprise identifying clusters of genes associated with metastasis by applying correlation-based clustering to the expression level of the genes. In one embodiment, the clusters of genes that define each metagene are identifred using supervised classification methods of analysis previously described. See, for example, West, M.
et al. Proc Natl Acad Sci USA 98, 11462-11467 (2001). The analysis selects a set of genes whose expression levels are most highly correlated with the classification of tumor samples into sensitivity to an anti-cancer agent versus no sensitivity to an anti-cancer agent. The dominant principal components from such a set of genes then defines a relevant phenotype-related metagene, and regression models assign the relative probability of sensitivity to an anti-cancer agent.

[01351 In one embodiment, identification of the clusters comprises screening genes to reduce the number by eliminating genes that show limited variation across samples or that are evidently expressed at low levels that are not detectable at the resolution of the gene expression technology used to measure levels. This removes noise and reduces the dimension of the predictor variable. In one embodiment, identification of the clusters comprises clustering the genes using k-means, correlated-based clustering. Any standard statistical package may be used, such as the xcluster software created by Gavin Sherlock (http://genetics.stanford.edu/-sherlock/cluster.html). A large number of clusters may be targeted so as to capture multiple, correlated patterns of variation across samples, and generally small numbers of genes within clusters. In one embodiment, identification of the clusters comprises extracting the dominant singular factor (principal component) from each of the resulting clusters.
Again, any standard statistical or numerical software package may be used for this; this analysis uses the efficient, reduced singular value decomposition function. In one embodiment, the foregoing methods comprise defining one or more metagenes, wherein each metagene is defined by extracting a single dominant value using single value decomposition (SVD) from a cluster of genes associated with estimating the efficacy of a therapeutic agent in treating a subject afflicted with cancer.

im(,4,) 1 '7 1 nnr [0136] In one embodiment, the methods for defining one or more statistical tree models predictive of cancer sensitivity to an anti-cancer agent comprise defining a statistical tree model, wherein the model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of the efficacy of a therapeutic agent in treating a subject afflicted with cancer. This generates multiple recursive partitions of the sample into subgroups (the "leaves" of the classification tree), and associates Bayesian predictive probabilities of outcomes with each subgroup. Overall predictions for an individual sample are then generated by averaging predictions, with appropriate weights, across many such tree models. Iterative out-of-sample, cross-validation predictions are then performed leaving each tumor out of the data set one at a time, refitting the model from the remaining tumors and using it to predict the hold-out case. This rigorously tests the predictive value of a model and mirrors the real-world prognostic context where prediction of new cases as they arise is the major goal.
[0137] In one embodiment, a formal Bayes' factor measure of association may be used in the generation of trees in a forward-selection process as implemented in traditional classification tree approaches. Consider a single tree and the data in a node that is a candidate for a binary split. Given the data in this node, one may construct a binary split based on a chosen (predictor, threshold) pair (x, i) by (a) finding the (predictor, threshold) combination that maximizes the Bayes' factor for a split, and (b) splitting if the resulting Bayes' factor is sufficiently large. By reference to a posterior probability scale with respect to a notional 50:50 prior, Bayes' factors of 2.2 ,2.9, 3.7 and 5.3 correspond, approximately, to probabilities of 0.9, 0.95, 0.99 and 0.995, respectively. This guides the choice of threshold, which may be specified as a single value for each level of the tree. Bayes' factor thresholds of around 3 in a range of analyses may be used.
Higher thresholds limit the growth of trees by ensuring a more stringent test for splits.

[0138] In one non-limiting exemplary embodiment of generating statistical tree models, prior to statistical modeling, gene expression data is filtered to exclude probe sets with signals present at background noise levels, and for probe sets that do not vary significantly across tumor samples. A metagene represents a group of genes that together exhibit a consistent pattern of expression in relation to an observable phenotype. Each signature summarizes its constituent genes as a single expression profile, and is here derived as the first principal component of that set of genes (the factor corresponding to the largest singular value) as determined by a singular value decomposition. Given a training set of expression vectors (of values across metagenes) i n7(.n')1"7 1 nnr representing two biological states, a binary probit regression model may be estimated using Bayesian methods. Applied to a separate validation data set, this leads to evaluations of predictive probabilities of each of the two states for each case in the validation set. When predicting sensitivity to an anti-cancer agent from an Tumor sample, gene selection and identification is based on the training data, and then metagene values are computed using the principal components of the training data and additional expression data.
Bayesian fitting of binary probit regression models to the training data then permits an assessment of the relevance of the metagene signatures in within-sample classification, and estimation and uncertainty assessments for the binary regression weights mapping metagenes to probabilities of relative pathway status. Predictions of sensitivity to an anti-cancer agent are then evaluated, producing estimated relative probabilities - and associated measures of uncertainty - of sensitivity to an anti-cancer agent across the validation samples. Hierarchical clustering of sensitivity to anti-cancer agent predictions may be performed using Gene Cluster 3.0 testing the null hypothesis, which is that the survival curves are identical in the overall population.

[0139] In one embodiment, the each statistical tree model generated by the methods described herein comprises 2, 3, 4, 5, 6 or more nodes. In one embodiment of the methods described herein for defining a statistical tree model predictive of sensitivity/resistance to a therapeutic, the resulting model predicts cancer sensitivity to an anti-cancer agent with at least 70%, 80%, 85%, or 90% or higher accuracy. In another embodiment, the model predicts sensitivity to an anti-cancer agent with greater accuracy than clinical variables. In one embodiment, the clinical variables are selected from age of the subject, gender of the subject, tumor size of the sample, stage of cancer disease, histological subtype of the sample and smoking history of the subject. In one embodiment, the cluster of genes that define each metagene comprise at least 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 genes. In one embodiment, the correlation-based clustering is Markov chain correlation-based clustering or K-means clustering.
Diagnostic Business Methods [0140] One aspect of the invention provides methods of conducting a diagnostic business, including a business that provides a health care practitioner with diagnostic information for the treatment of a subject afflicted with cancer. One such method comprises one, more than one, or all of the following steps: (i) obtaining an tumor sample from the subject;
(ii) determining the ..
expression level of multiple genes in the sample; (iii) defining the value of one or more i (Y7F.q') 1'7 1 nnr metagenes from the expression levels of step (ii), wherein each metagene is defined by extracting a single dominant value using single value decomposition (SVD) from a cluster of genes associated with sensitivity to an anti-cancer agent; (iv) averaging the predictions of one or more statistical tree models applied to the values, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical prcdictive probability of sensitivity to an anti-cancer agent, wherein at least one metagene is one of metagenes 1-7; and (v) providing the health care practitioner with the prediction from step (iv).
[0141] In one embodiment, obtaining a tumor sample from the subject is effected by having an agent of the business (or a subsidiary of the business) remove a tumor sample from the subject, such as by a surgical procedure. In another embodiment, obtaining a tumor sample from the subject comprises receiving a sample from a health care practitioner, such as by shipping the sample, preferably frozen. In one embodiment, the sample is a cellular sample, such as a mass of tissue. In one embodiment, the sample comprises a nucleic acid sample, such as a DNA, cDNA, mRNA sample, or combinations thereof, which was derived from a cellular tumor sample from the subject. In one embodiment, the prediction from step (iv) is provided to a health care practitioner, to the patient, or to any other business entity that has contracted with the subject.

101421 In one embodiment, the method comprises billing the subject, the subject's insurance carrier, the health care practitioner, or an employer of the health care practitioner. A government agency, whether local, state or federal, may also be billed for the services.
Multiple parties may also be billed for the service.

[0143] In some embodiments, all the steps in the method are carried out in the same general location. In certain embodiments, one or more steps of the methods for conducting a diagnostic business are performed in different locations. In one embodiment, step (ii) is performed in a first location, and step (iv) is performed in a second location, wherein the first location is remote to the second location. The other steps may be performed at either the first or second location, or in other locations. In one embodiment, the first location is remote to the second location. A
remote location could be another location (e.g. office, lab, etc.) in the same city, another location in a different city, another location in a different state, another location in a different country, etc. As such, when one item is indicated as being "remote" from another, what is meant is that the two items are at least in different buildings, and may be at least one mile, ten miles, or at 1 n764) 17 1 nnr least one hundred miles apart. In one embodiment, two locations that are remote relative to each other are at least 1, 2, 3, 4, 5, 10, 20, 50, 100, 200, 500, 1000, 2000 or 5000 km apart. In another embodiment, the two locations are in different countries, where one of the two countries is the United States.

[0144] Some specific embodiments of the methods described herein where steps are performed in two or more locations comprise one or more steps of communicating inforrnation between the two locations. "Communicating" information means transmitting the data representing that information as electrical signals over a suitable communication channel (for example, a private or public network). "Forwarding" an item refers to any means of getting that item from one location to the next, whether by physically transporting that item or otherwise (where that is possible) and includes, at least in the case of data, physically transporting a medium carrying the data or communicating the data. The data may be transmitted to the remote location for further evaluation and/or use. Any convenient telecommunications means may be employed for transmitting the data, e.g., facsimile, modem, internet, etc.

[0145] In one specific embodiment, the method comprises one or more data transmission steps between the locations. In one embodiment, the data transmission step occurs via an electronic communication link, such as the internet. In one embodiment, the data transmission step from the first to the second location comprises experimental parameter data, such as the level of gene expression of multiple genes. In some embodiments, the data transmission step from the second location to the first location comprises data transmission to intermediate locations. In one specific embodiment, the method comprises one or more data transmission substeps from the second location to one or more intermediate locations and one or more data transmission substeps from one or more intermediate locations to the first location, wherein the intermediate locations are remote to both the first and second locations. In another embodiment, the method comprises a data transmission step in which a result from gene expression is transmitted from the second location to the first location.

[0146] In one embodiment, the methods of conducting a diagnostic business comprise the step of determining if the subject carries an allelic form of a gene whose presence correlates to sensitivity or resistance to a chemotherapeutic agent. This may be achieved by analyzing a nucleic acid sample from the patient and determining the DNA sequence of the allele. Any technique known in the art for determining the presence of mutations or polymorphisms may be 1 n7AQ)1 7 i nnr used. The method is not limited to any particular mutation or to any particular allele or gene.
For example, mutations in the epidermal growth factor receptor (EGFR) gene are found in human lung adenocarcinomas and are associated with sensitivity to the tyrosine kinase inhibitors gefitinib and erlotinib. (See, e.g., Yi et al. Proc Natl Acad Sci U S A. 2006 May 16;103(20):7817-22; Shimato et al. Neuro-oncol. 2006 Apr;8(2):137-44).
Similarly, mutations in breast cancer resistance protein (BCRP) modulate the resistance of cancer cells to BCRP-substrate anticancer agents (Yanase et al., Cancer Lett. 2006 Mar 8;234(1):73-80).

Arrays and Gene Chips and Kits Comprising Thereof [0147] Arrays and microarrays which contain the gene expression profiles for determining responsivity to platinum-based therapy and/or responsivity to salvage agents are also encompassed within the scope of this invention. Methods of making arrays are well-known in the art and as such, do not need to be described in detail here.

[0148] Such arrays can contain the profiles of at least 5, 10, 15, 25, 50, 75, 100, 150, or 200 genes as disclosed in Table 1. Accordingly, arrays for detection of responsivity to particular therapeutic agents can be customized for diagnosis or treatment of ovarian cancer. The array can be packaged as part of kit comprising the customized array itself and a set of instructions for how to use the array to determine an individual's responsivity to a specific cancer therapeutic agent.

[0149] Also provided are reagents and kits thereof for practicing one or more of the above described methods. The subject reagents and kits thereof may vary greatly.
Reagents of interest include reagents specifically designed for use in production of the above described metagene values.

[0150] One type of such reagent is an array probe of nucleic acids, such as a DNA chip, in which the genes defining the metagenes in the therapeutic efficacy predictive tree models are represented. A variety of different array formats are known in the art, with a wide variety of different probe structures, substrate compositions and attachment technologies. Representative array structures of interest include those described in U.S. Pat. Nos.
5,143,854; 5,288,644;
5,324,633; 5,432,049; 5,470,710; 5,492,806; 5,503,980; 5,510,270; 5,525,464;
5,547,839;
5,580,732; 5,661,028; 5,800,992; the disclosures of which are herein incorporated by reference;

imcrn-r i r~nr =

;=
as well as WO 95/21265; WO 96/31622; WO 97/10365; WO 97/27317; EP 373 203; and 280.
[0151] The DNA chip is convenient to compare the expression levels of a number of genes at the same time. DNA chip-based expression profiling can be carried out, for example, by the method as disclosed in "Microarray Biochip Technology" (Mark Schena, Eaton Publishing, 2000). A DNA chip comprises immobilized high-density probes to detect a number of genes.
Thus, the expression levels of many genes can be estimated at the same time by a single-round analysis. Namely, the expression profile of a specimen can be determined with a DNA chip. A
DNA chip may comprise probes, which have been spotted thereon, to detect the expression level of the metagene-defining genes of the present invention. A probe may be designed for each marker gene selected, and spotted on a DNA chip. Such a probe may be, for example, an oligonucleotide comprising 5-50 nucleotide residues. A method for synthesizing such oligonucleotides on a DNA chip is known to those skilled in the art. Longer DNAs can be synthesized by PCR or chemically. A method for spotting long DNA, which is synthesized by PCR or the like, onto a glass slide is also known to those skilled in the art.
A DNA chip that is obtained by the method as described above can be used estimating the efficacy of a therapeutic agent in treating a subject afflicted with cancer according to the present invention.

[0152] DNA microarray and methods of analyzing data from microarrays are well-described in the art, including in DNA Microarrays: A Molecular Cloning Manual, Ed. by Bowtel and Sambrook (Cold Spring Harbor Laboratory Press, 2002); Microarrays for an Integrative Genomics by Kohana (MIT Press, 2002); A Biologist's Guide to Analysis ofDNA
Microarray Data, by Knudsen (Wiley, John & Sons, Incorporated, 2002); DNA Microarrays: A
Practical Approach, Vol. 205 by Schema (Oxford University Press, 1999); and Methods of Microarray Data Analysis II, ed. by Lin et al. (Kluwer Academic Publishers, 2002).

[0153] One aspect of the invention provides a gene chip having a plurality of different oligonucleotides attached to a first surface of the solid support and having specificity for a plurality of genes, wherein at least 50% of the genes are common to those of metagenes 1, 2, 3, 4, 5, 6 and/or 7. In one embodiment, at least 70%, 80%, 90% or 95% of the genes in the gene chip are common to those of metagenes 1, 2, 3, 4, 5, 6 and/or 7.

i n uo~ i v ~ nnr [0154] One aspect of the invention provides a kit comprising: (a) any of the gene chips described herein; and (b) one of the computer-readable mediums described herein.

[0155] In some embodiments, the arrays include probes for at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 40, or 50 of the genes listed in Table 1. In certain embodiments, the number of genes that are from Table 1 that are represented on the array is at least 5, at least 10, at least 25, at least 50, at least 75 or more, including all of the genes listed in the table. Where the subject arrays include probes for additional genes not listed in the tables, in certain embodiments the number % of additional genes that are represented does not exceed about 50%, 40%, 30%, 20%, 15%, 10%, 8%, 6%, 5%, 4%, 3%, 2% or 1%. In some embodiments, a great majority of genes in the collection are genes that define the metagenes of the invention, where by great majority is meant at least about 75%, usually at least about 80% and sometimes at least about 85, 90, 95%
or higher, including embodiments where 100% of the genes in the collection are metagene-defining genes.

[0156] The kits of the subject invention may include the above described arrays. The kits may further include one or more additional reagents employed in the various methods, such as primers for generating target nucleic acids, dNTPs and/or rNTPs, which may be either premixed or separate, one or more uniquely labeled dNTPs and/or rNTPs, such as biotinylated or Cy3 or Cy5 tagged dNTPs, gold or silver particles with different scattering spectra, or other post synthesis labeling reagent, such as chemically active derivatives of fluorescent dyes, enzymes, such as reverse transcriptases, DNA polymerases, RNA polymerases, and the like, various buffer mediums, e.g. hybridization and washing buffers, prefabricated probe arrays, labeled probe purification reagents and components, like spin columns, etc., signal generation and detection reagents, e.g. streptavidin-alkaline phosphatase conjugate, chemifluorescent or chemiluminescent substrate, and the like.

[0157] In addition to the above components, the subject kits will further include instructions for practicing the subject methods. These instructions may be present in the subject kits in a variety of forms, one or more of which may be present in the kit. One form in which these instructions may be present is as printed information on a suitable medium or substrate, e.g., a piece or pieces of paper on which the information is printed, in the packaging of the kit, in a package insert, etc. Yet another means would be a computer readable medium, e.g., diskette, CD, etc., on which the information has been recorded. Yet another means that may be present is a website address which may be used via the internet to access the information at a removed site.
Any convenient means may be present in the kits.

[0158] The kits also include packaging material such as, but not limited to, ice, dry ice, styrofoam, foam, plastic, cellophane, shrink wrap, bubble wrap, paper, cardboard, starch peanuts, twist ties, metal clips, metal cans, drierite, glass, and rubber (see products available from www.papermart.com. for examples of packaging material).

Computer Readable Media Comprising Gene Expression Profiles [0159] The invention also contemplates computer readable media that comprises gene expression profiles. Such media can contain all of part of the gene expression profiles of the genes listed in Table 1. The media can be a list of the genes or contain the raw data for running a user's own statistical calculation, such as the methods disclosed herein.

Program Products/S sty ems [0160] Another aspect of the invention provides a program product (i.e., software product) for use in a computer device that executes program instructions recorded in a computer-readable medium to perform one or more steps of the methods described herein, such for estimating the efficacy of a therapeutic agent in treating a subject afflicted with cancer.

[0161] One aspect of the invention provides a computer readable medium having computer readable program codes embodied therein, the computer readable medium program codes performing one or more of the following functions: defining the value of one or more metagenes from the expression levels genes; defining a metagene value by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to a therapeutic agent; averaging the predictions of one or more statistical tree models applied to the values of the metagenes; or averaging the predictions of one or more binary regression models applied to the values of the metagenes, wherein each model includes a statistical predictive probability of tumor sensitivity to a therapeutic agent.

[0162] Another related aspect of the invention provides kits comprising the program product or the computer readable medium, optionally with a computer system. One aspect of the invention provides a system, the system comprising: a computer; a computer readable medium, in^cmi~ i nn~ !

operatively coupled to the computer, the computer readable medium program codes performing one or more of the following functions: defining the value of one or more metagenes from the expression levels genes; defining a metagene value by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to a therapeutic agent; averaging the predictions of one or more statistical tree models applied to the values of the metagenes; or averaging the predictions of one or more binary regression models applied to the values of the metagenes, wherein each model includes a statistical predictive probability of tumor sensitivity to a therapeutic agent.

[0163] In one embodiment, the program product comprises: a recordable medium;
and a plurality of computer-readable instructions executable by the computer device to analyze data from the array hybridization steps, to transmit array hybridization from one location to another, or to evaluate genome-wide location data between two or more genomes. Computer readable media include, but are not limited to, CD-ROM disks (CD-R, CD-RW), DVD-RAM
disks, DVD-RW disks, floppy disks and magnetic tape.

[0164] A related aspect of the invention provides kits comprising the program products described herein. The kits may also optionally contain paper and/or computer-readable format instructions and/or information, such as, but not limited to, information on DNA microarrays, on tutorials, on experimental procedures, on reagents, on related products, on available experimental data, on using kits, on chemotherapeutic agents including there toxicity, and on other information. The kits optionally also contain in paper and/or computer-readable format information on minimum hardware requirements and instructions for running and/or installing the software. The kits optionally also include, in a paper and/or computer readable format, information on the manufacturers, warranty information, availability of additional software, technical services information, and purchasing information. The kits optionally include a video or other viewable medium or a link to a viewable format on the internet or a network that depicts the use of the use of the software, and/or use of the kits. The kits also include packaging material such as, but not limited to, styrofoam, foam, plastic, cellophane, shrink wrap, bubble wrap, paper, cardboard, starch peanuts, twist ties, metal clips, metal cans, drierite, glass, and rubber.
[0165) The analysis of data, as well as the transmission of data steps, can be implemented by the use of one or more computer systems. Computer systems are readily available. The processing that provides the displaying and analysis of image data for example, can be 1 (17/.Q')1 '7 1 nnr i=
performed on multiple computers or can be performed by a single, integrated computer or any variation thereof. For example, each computer operates under control of a central processor unit (CPU), such as a "Pentium" microprocessor and associated integrated circuit chips, available from Intel Corporation of Santa Clara, Calif., USA. A computer user can input commands and data from a keyboard and display mouse and can view inputs and computer output at a display.
The display is typically a video monitor or flat panel display device. The computer also includes a direct access storage device (DASD), such as a fixed hard disk drive. The memory typically includes volatile semiconductor random access memory (RAM).

[0166] Each computer typically includes a program product reader that accepts a program product storage device from which the program product reader can read data (and to which it can optionally write data). The program product reader can include, for example, a disk drive, and the program product storage device can include a removable storage medium such as, for example, a magnetic floppy disk, an optical CD-ROM disc, a CD-R disc, a CD-RW
disc and a DVD data disc. If desired, computers can be connected so they can communicate with each other, and with other connected computers, over a network. Each computer can communicate with the other connected computers over the network through a network interface that permits communication over a connection between the network and the computer.

[0167] The computer operates under control of programming steps that are temporarily stored in the memory in accordance with conventional computer construction.
When the programming steps are executed by the CPU, the pertinent system components perform their respective functions. Thus, the programming steps implement the functionality of the system as described above. The programming steps can be received from the DASD, through the program product reader or through the network connection. The storage drive can receive a program product, read programming steps recorded thereon, and transfer the programming steps into the memory for execution by the CPU. As noted above, the program product storage device can =
include any one of multiple removable media having recorded computer-readable instructions, including magnetic floppy disks and CD-ROM storage discs. Other suitable program product storage devices can include magnetic tape and semiconductor memory chips. In this way, the processing steps necessary for operation can be embodied on a program product.

[0168] Alternatively, the program steps can be received into the operating memory over the network. In the network method, the computer receives data including program steps into the i n7(,Q')17 I n(N' memory through the network interface after network communication has been established over the network connection by well known methods understood by those skilled in the art. The computer that implements the client side processing, and the computer that implements the server side processing or any other computer device of the system, can include any conventional computer suitable for implementing the functionality described herein.

[0169] Figure 15 shows a functional block diagram of general purpose computer system 1500 for performing the functions of the software according to an illustrative embodiment of the invention. The exemplary computer system 1500 includes a central processing unit (CPU) 3002, a memory 1504, and an interconnect bus 1506. The CPU 1502 may include a single microprocessor or a plurality of microprocessors for configuring computer system 1500 as a multi-processor system. The memory 1504 illustratively includes a main memory and a read only memory. The computer 1500 also includes the mass storage device 1508 having, for example, various disk drives, tape drives, etc. The main memory 1504 also includes dynamic random access memory (DRAM) and high-speed cache memory. In operation, the main memory 1504 stores at least portions of instructions and data for execution by the CPU 1502.
[0170] The mass storage 1508 may include one or more magnetic disk or tape drives or optical disk drives, for storing data and instructions for use by the CPU
1502. At least one component of the mass storage system 1508, preferably in the form of a disk drive or tape drive, stores one or more databases, such as databases containing of transcriptional start sites, genomic sequence, promoter regions, or other information.

[0171] The mass storage system 1508 may also include one or more drives for various portable media, such as a floppy disk, a compact disc read only memory (CD-ROM), or an integrated circuit non-volatile memory adapter (i.e., PC-MCIA adapter) to input and output data and code to and from the computer system 1500.

[0172] The computer system 1500 may also include one or more input/output interfaces for communications, shown by way of example, as interface 1510 for data communications via a network. The data interface 1510 may be a modem, an Ethernet card or any other suitable data communications device. To provide the functions of a computer system according to Figure 15 the data interface 1510 may provide a relatively high-speed link to a network, such as an intranet, internet, or the Internet, either directly or through an another external interface. The im6mi7 1 nnr communication link to the network may be, for example, optical, wired, or wireless (e.g., via satellite or cellular network). Alternatively, the computer system 1500 may include a mainframe or other type of host computer system capable of Web-based communications via the network.
[0173] The computer system 1500 also includes suitable input/output ports or use the interconnect bus 1506 for interconnection with a local display 1512 and keyboard 1514 or the like serving as a local user interface for programming and/or data retrieval purposes.
Alternatively, server operations personnel may interact with the system 1500 for controlling and/or programming the system from remote terminal devices via the network.

[0174] The computer system 1500 may run a variety of application programs and stores associated data in a database of mass storage system 1508. One or more such applications may enable the receipt and delivery of messages to enable operation as a server, for implementing server functions relating to obtaining a set of nucleotide array probes tiling the promoter region of a gene or set of genes.

[0175] The components contained in the computer system 1500 are those typically found in general purpose computer systems used as servers, workstations, personal computers, network terminals, and the like. In fact, these components are intended to represent a broad category of such computer components that are well known in the art.

[0176] It will be apparent to those of ordinary skill in the art that methods involved in the present invention may be embodied in a computer program product that includes a computer usable and/or readable medium. For example, such a computer usable medium may consist of a read only memory device, such as a CD ROM disk or conventional ROM devices, or a random access memory, such as a hard drive device or a computer diskette, having a computer readable program code stored thereon.

[0177] The following examples are provided to illustrate aspects of the invention but are not intended to limit the invention in any manner.

~m~o~,~ i nnr EXAMPLES
Example 1 A gene expression based predictor of sensitivity to docetaxel [0178] To develop predictors of cytotoxic chemotherapeutic drug response, we used an approach similar to previous work analyzing the NCI-60 panel,49 first identifying cell lines that were most resistant or sensitive to docetaxel (Figure IA, B) and then genes whose expression most highly correlated with drug sensitivity, using Bayesian binary regression analysis to develop a model that differentiates a pattern of docetaxel sensitivity from resistance. A gene expression signature consisting of 50 genes was identified that classified on the basis of docetaxel sensitivity (Figure 1 B, bottom panel).

[0179] In addition to leave-one-out cross validation, we utilized an independent dataset derived from docetaxel sensitivity assays in a series of 301ung and ovarian cancer cell lines for further validation. As shown in Figure 1 C (top panel), the correlation between the predicted probability of sensitivity to docetaxel (in both lung and ovarian cell lines) and the respective IC50 for docetaxel confirmed the capacity of the docetaxel predictor to predict sensitivity to the drug in cancer cell lines (Figure 7). In each case, the accuracy exceeded 80%.
Finally, we made use of a second independent dataset that measured docetaxel sensitivity in a series of 29 lung cancer cell lines (Gemma A, GEO accession number: GSE 4127). As shown in Figure 1 C
(bottom panel), the docetaxel sensitivity model developed from the NCI-60 panel again predicted sensitivity in this independent dataset, again with an accuracy exceeding 80%.
Example 2 Utilization of the expression signature to predict docetaxel response in patients [0180] The development of a gene expression signature capable of predicting in vitro docetaxel sensitivity provides a tool that might be useful in predicting response to the drug in patients. We have made use of published studies with clinical and genomic data that linked gene expression data with clinical response to docetaxel in a breast cancer neoadjuvant study50 (Figure 1 D) to test the capacity of the in vitro docetaxel sensitivity predictor to accurately identify those patients that responded to docetaxel. Using a 0.45 predicted probability of response as the cut-off for predicting positive response, as determined by ROC
curve analysis (Figure 7A), the in vitro generated profile correctly predicted docetaxel response in 22 out of 24 patient samples, achieving an overall accuracy of 91.6% (Figure 1D). Applying a Mann-Whitney U test for statistical significance demonstrates the capacity of the predictor to distinguish resistant from sensitive patients (Figure 1D, right panel). We extended this further by predicting the response to docetaxel as salvage therapy for ovarian cancer.
As shown in Figure 1 E, the prediction of response to docetaxel in patients with advanced ovarian cancer achieved an accuracy exceeding 85% (Figure 1 E, middle panel). Further, an analysis of statistical significance demonstrated the capacity of the predictors to distinguish patients with resistant versus sensitive disease (Figure 1 E, right panel).

[0181] We also performed a complementary analysis using the patient response data to generate a predictor and found that the in vivo generated signature of response predicted sensitivity of NCI-60 cell lines to docetaxel (Figure 7B). This crossover is further emphasized by the fact that the genes represented in either the initial in vitro generated docetaxel predictor or the alternative in vivo predictor exhibit considerable overlap. Importantly, both predictors link to expected targets for docetaxel including bcl-2, TRAG, erb-B2, and tubulin genes, all previously described to be involved in taxane chemoresistances1-s4 (Table 1).
We also note that the predictor of docetaxel sensitivity developed from the NCI-60 data was more accurate in predicting patient response in the ovarian samples than the predictor developed from the breast neoadjuvant patient data (85.7% vs. 64.3%) (Figure 7C).

Example 3 Development of a panel of gene expression signatures that predict sensitivity to chemotherapeutic drugs [0182] Given the development of a docetaxel response predictor, we have examined the NCI-60 dataset for other opportunities to develop predictors of chemotherapy response. Shown in Figure 2A are a series of expression profiles developed from the NCI-60 dataset that predict response to topotecan, adriamycin, etoposide, 5-flourouracil (5-FU), taxol, and cyclophosphamide. In each case, the leave-one-out cross validation analyses demonstrate a capacity of these profiles to accurately predict the samples utilized in the development of the predictor (Figure 8, middle panel). Each profile was then further validated using in vitro response data from independent datasets; in each case, the profile developed from the NCI-60 data was capable of accurately (> 85%) predicting response in the separate dataset of approximately 30 cancer cell lines for which the dose response information and relevant Affymetrix U133A gene expression data is publicly available37 (Figure 8 (bottom panel) and Table 2). Once again, applying a Mann-Whitney U test for statistical significance demonstrates the capacity of the predictor to distinguish resistant from sensitive patients (Figure 2B).

[0183] In addition to the capacity of each signature to distinguish cells that are sensitive or resistant to a particular drug, we also evaluated the extent to which a signature was also specific for an individual chemotherapeutic agent. From the example shown in Figure 9, using the validations of chemosensitivity seen in the independent European (IJC) cell line data it is clear that each of the signatures is specific for the drug that was used to develop the predictor. In each case, individual predictors of response to the various cytotoxic drugs was plotted against cell lines known to be sensitive or resistant to a given chemotherapeutic agent (e.g., adriamycin, paclitaxel).

[0184] Given the ability of the in vitro developed gene expression profiles to predict response to docetaxel in the clinical samples, we extended this approach to test the ability of additional signatures to predict response to commonly used salvage therapies for ovarian cancer and an independent dataset of samples from adriamycin treated patients (Evans W, GSE650, GSE651). As shown in Figure 5C, each of these predictors was capable of accurately predicting the response to the drugs in patient samples, achieving an accuracy in excess of 81 % overall. In each case, the positive and negative predictive values confirm the validity and clinical utility of the approach (Table 2).

Example 4 Chemotherapy response signatures predict response to multi-drug regimens [0185] Many therapeutic regimens make use of combinations of chemotherapeutic drugs raising the question as to the extent to which the signatures of individual therapeutic response will also predict response to a combination of agents. To address this question, we have made use of data from a breast neoadjuvant treatment that involved the use of paclitaxel, 5-flourouracil, adriamycin, and cyclophosphamide (TFAC)ss,s6 (Figure 3A). Using available data from the 51 patients to then predict response with each of the single agent signatures (paclitaxel, 5-FU, adriamycin and cyclophosphamide) developed from the NCI-60 cell line analysis; we then compared to the clinical outcome information which was represented as complete pathologic response. As shown in Figure 3A (middle panel), the predicted response based on each of the individual chemosensitivity signatures indicated a significant distinction between the responders (n = 13) and non-responders (n = 38) with the exception of 5-flourouracil.
Importantly, the im~o~i~ i nnr combined probability of sensitivity to the four agents in this TFAC
neoadjuvant regimen was calculated using the probability theorem and it is clear from this analysis that the prediction of response based on a combined probability of sensitivity, built from the individual chemosensitivity predictions yielded a statistically significant (p < 0.0001, Mann Whitney U) distinction between the responders and non-responders (Figure 3A, right panel).

[0186] As a further validation of the capacity to predict response to combination therapy, we have made use of gene expression data generated from a collection of breast cancer (n = 45) samples from patients who received 5-flourouracil, adriamycin and cyclophosphamide (FAC) in the adjuvant chemotherapy set. As shown in Figure 3B (left panel), the predicted response based on signatures for 5-FU, adriamycin, and cyclophosphamide indicated a significant distinction between the responders (n = 34) and non-responders (n = 11) for each of the single agent predictors. Furthermore, the combined probability of sensitivity to the three agents in the FAC
regimen was calculated and shown in the middle panel of Figure 3B. It is evident from this analysis that the prediction of response based on a combined probability of sensitivity to the FAC regimen yielded a clear, significant (p < 0.001, Mann Whitney U) distinction between the responders and non-responders (accuracy: 82.2%, positive predictive value:
90.3%, negative predictive value: 64.3%). We note that while it is difficult to interpret the prediction of clinical response in the adjuvant setting since many of these patients were likely free of disease following surgery, the accurate identification of non-responders is a clear endpoint that does confirm the capacity of the signatures to predict clinical response.

[0187] As a further measure of the relevance of the predictions, we examined the prognostic significance of the ability to predict response to FAC. As shown in Figure 3B
(right panel), there was a clear distinction in the population of patients identified as sensitive or resistant to FAC, as measured by disease-free survival. These results, taken together with the accuracy of prediction of response in the neoadjuvant setting where clinical endpoints are uncomplicated by confounding variables such as prior surgery, and results of the single agent validations, leads us to conclude that the signatures of chemosensitivity generated from the NCI-60 panel do indeed have the capacity to predict therapeutic response in patients receiving either single agent or combination chemotherapy (Table 3).

101881 When comparing individual genes that constitute the predictors, it was interesting to observe that the gene coding for MAP-Tau, described previously as a determinant of paclitaxel sensitivity,56 was also identified as a discriminator gene in the paclitaxel predictor generated using the NCI-60 data. Although, similar to the docetaxel example described earlier, a predictor for TFAC chemotherapy developed using the NCI-60 data was superior to the ability of the MAP-Tau based predictor described by Pusztai et al (Table 4). Similarly, p53, methyltetrahydrofolate reductase gene and DNA repair genes constitute the 5-flourouracil predictor, and excision repair mechanism genes (e.g., ERCC4), retinoblastoma pathway genes, and bcl-2 constitute the adriamycin predictor, consistent with previous reports (Table 1).
Example 5 Patterns of predicted chemotheraRy response across a spectrum of tumors [0189] The availability of genomic-based predictors of chemotherapy response could potentially provide an opportunity for a rational approach to selection of drugs and combination of drugs. With this in mind, we have utilized the panel of chemotherapy response predictors described in Figure 6 to profile the potential options for use of these agents, by predicting the likelihood of sensitivity to the seven agents in a large collection of breast, lung, and ovarian tumor samples. We then clustered the samples according to patterns of predicted sensitivity to the various chemotherapeutics, and plotted a heatmap in which high probability of sensitivity response is indicated by red and low probability or resistance is indicated by blue (Figure 4).
[0190] As shown in Figure 3, there are clearly evident patterns of predicted sensitivity to the various agents. In many cases, the predicted sensitivities to the chemotherapeutic agents are consistent with the previously documented efficacy of single agent chemotherapies in the individual tumor types57. For instance, the predicted response rate for etoposide, adriamycin, cyclophosphamide, and 5-FU approximate the observed response for these single agents in breast cancer patients (Figure 10). Likewise, the predicted sensitivity to etoposide, docetaxel, and paclitaxel approximates the observed response for these single agents in lung cancer patients (Figure 10). This analysis also suggests possibilities for alternate treatments. As an example, it would appear that breast cancer patients likely to respond to 5-flourouracil are resistant to adriamycin and docetaxel (Figure 11A). Likewise, in lung cancer, docetaxel sensitive populations are likely to be resistant to etoposide (Figure 11 B). This is a potentially useful observation considering that both etoposide and docetaxel are viable front-line options (in conjunction with cis/carboplatin) for patients with lung cancer.58 A similar relationship is seen between topotecan and adriamycin, both agents used in salvage chemotherapy for ovarian cancer (Figure 11 C). Thus, by identifying patients/patient cohorts resistant to certain standard of care in7f,0117 I nnr agents, one could avoid the side effects of that agent (e.g. topotecan) without compromising patient outcome, by choosing an alternative standard of care (e.g., adriamycin).

Example 6 Linking predictions of chemotherapy sensitivity to oncogenic pathway deregulation [0191] Most patients who are resistant to chemotherapeutic agents are then recruited into a second or third line therapy or enrolled to a clinical tria1.38'19 Moreover, even those patients who initially respond to a given agent are likely to eventually suffer a relapse and in either case, additional therapeutic options are needed. As one approach to identifying such options, we have taken advantage of our recent work that describes the development of gene expression signatures that reflect the activation of several oncogenic pathways.36 To illustrate the approach, we first stratified the NCI cell lines based on predicted docetaxel response and then examined the patterns of pathway deregulation associated with docetaxel sensitivity or resistance (Figure 13A). Regression analysis revealed a significant relationship between P13 kinase pathway deregulation and docetaxel resistance, as seen by the linear relationship (p =
0.001) between the probability of P13 kinase activation and the IC50 of docetaxel in the cell lines (Figure 12, 28B, and Table 5).

101921 The results linking docetaxel resistance with deregulation of the P13 kinase pathway, suggests an opportunity to employ a P13 kinase inhibitor in this subgroup, given our recent observations that have demonstrated a linear positive correlation between the probability of pathway deregulation and targeted drug sensitivity.36 To address this directly, we predicted docetaxel sensitivity and probability of oncogenic pathway deregulation using DNA microarray data from 17 NSCLC cell lines (Figure 5A, left panel). Consistent with the analysis of the NCI-60 cell line panel, the cell lines predicted to be resistant to docetaxel were also predicted to exhibit P13 kinase pathway activation (p = 0.03, log-rank test, Figure 14). In parallel, the lung cancer cell lines were subjected to assays for sensitivity to a P13 kinase specific inhibitor (LY-294002), using a standard measure of cell proliferation.36' 38' s9 As shown by the analysis in Figure 5B (left panel), the cell lines showing an increased probability of P13 kinase pathway activation were also more likely to respond to a P13 kinase inhibitor (LY-294002) (p = 0.001, log-rank test)). The same relationship held for prediction of resistance to docetaxel - these cells were more likely to be sensitive to P13 kinase inhibition (p < 0.001, log-rant test) (Figure 5B, left panel).

n~~o~i~ i nnr [0193] An analysis of a panel of ovarian cancer cell lines provided a second example.
Ovarian cell lines that are predicted to be topotecan resistant (Figure 5A, right panel) have a higher likelihood of Src pathway deregulation and there is a significant linear relationship (p =
0.001, log rank) between the probability of topotecan resistance and sensitivity to a drug that inhibits the Src pathway (SU6656) (Figure 5B, right panel). The results of these assays clearly demonstrate an opportunity to potentially mitigate drug resistance (e.g., docetaxel or topotecan) using a specific pathway-targeted agent, based on a predictor developed from pathway deregulation (i.e., P13 kinase or Src inhibition).

[0194] Taken together, these data demonstrate an approach to the identification of therapeutic options for chemotherapy resistant patients, as well as the identification of novel combinations for chemotherapy sensitive patients, and thus represents a potential strategy to a more effective treatment plan for cancer patients, after future prospective validations trials (Figure 6).

Example 7 Methods [0195] NCI-60 data. The (-1og10(M)) GI50/IC50, TGI (Total Growth Inhibition dose) and LC50 (50% cytotoxic dose) data was used to populate a matrix with MATLAB
software, with the relevant expression data for the individual cell lines. Where multiple entries for a drug screen existed (by NCS number), the entry with the largest number of replicates was included.
Incomplete data were assigned as Nan (not a number) for statistical purposes.
To develop an in vitro gene expression based predictor of sensitivity/resistance from the pharmacologic data used in the NCI-60 drug screen studies, we chose cell lines within the NCI-60 panel that would represent the extremes of sensitivity to a given chemotherapeutic agent (mean G150 +/- I SD).
Relevant expression data (updated data available on the Affymetrix U95A2 GeneChip) for the solid tumor cell lines and the respective pharmacological data for the chemotherapeutics was downloaded from the NCI website (http://dtp.nci.nih.gov/docs/cancer/cancer data.html). The individual drug sensitivity and resistance data from the selected solid tumor NCI-60 cell lines was then used in a supervised analysis using binary regression methodologies, as described previously,60 to develop models predictive of chemotherapeutic response.

[0196] Human ovarian cancer samples. We measured expression of 22,283 genes in ovarian cancer cell lines and 119 advanced (FIGO stage III/IV) serous epithelial ovarian i m~o~ i-r i nn~

carcinomas using Affymetrix U133A GeneChips. All ovarian cancers were obtained at initial cytoreductive surgery from patients. All tissues were collected under the auspices of respective institutional (Duke ilniversity Medical Center and H. Lee Moffitt Cancer Center) IRB approved protocols involving written informed consent.

[0197] Full details of the methods used for RNA extraction and development of gene expression signatures representing deregulation of oncogenic pathways in the tumor samples are recently described.36 Response to therapy was evaluated using standard criteria for patients with measurable disease, based upon WHO guidelines.28 [0198] Lung and ovarian cancer cell culture. Total RNA was extracted and oncogenic pathway predictions was performed similar to the methods described previously.36 [0199] Cross-platform Affymetrix Gene Chip comparison. To map the probe sets across various generations of Affymetrix GeneChip arrays, we utilized an in-house program, Chip Comparer (http://tenero.duhs.duke.edu/genearray/perl/chip/chipcomparer.pl) as described previously.36 [0200] Cell proliferation assays. Growth curves for cells were produced by plating 500-

10,000 cells per well in 96-well plates. The growth of cells at 12hr time points (from t=12 hrs) was determined using the Ce1lTiter 96 Aqueous One 23 Solution Cell Proliferation Assay Kit by Promega, which is a colorimetric method for determining the number of growing cells. 36 The growth curves plot the growth rate of cells vs. each concentration of drug tested against individual cell lines. Cumulatively, these experiments determined the concentration of cells to use for each cell line, as well as the dosing range of the inhibitors. The final dose-response curves in our experiments plot the percent of cell population responding to the chemotherapy vs.
the concentration of the drug for each cell line. Sensitivity to docetaxel and a phosphatidylinositol 3-kinase (P13 kinase) inhibitor (LY-294002) 36 in 171ung cell lines, and topotecan and a Src inhibitor (SU6656) in 13 ovarian cell lines was determined by quantifying the percent reduction in growth (versus DMSO controls) at 96 hrs using a standard MTT
colorimetric assay. 36 Concentrations used ranged from 1-IOnM for docetaxel, 300nM-10 M
(SU6656), and 300nM-10M for LY-294002. All experiments were repeated at least three times.

im~4~i~ i nnr [0201] Statistical analysis methods. Analysis of expression data are as previously described.
36, 60-62 Briefly, prior to statistical modeling, gene expression data is filtered to exclude probesets with signals present at background noise levels, and for probesets that do not vary significantly across samples. Each signature summarizes its constituent genes as a single expression profile, and is here derived as the top principal components of that set of genes. When predicting the chemosensitivity patterns or pathway activation of cancer cell lines or tumor samples, gene selection and identification is based on the training data, and then metagene values are computed using the principal components of the training data and additional cell line or tumor expression data. Bayesian fitting of binary probit regression models to the training data then permits an assessment of the relevance of the metagene signatures in within-sample classification,60 and estimation and uncertainty assessments for the binary regression weights mapping metagenes to probabilities. To guard against over-fitting given the disproportionate number of variables to samples, we also performed leave-one-out cross validation analysis to test the stability and predictive capability of our model. Each sample was left out of the data set one at a time, the model was refitted (both the metagene factors and the partitions used) using the remaining samples, and the phenotype of the held out case was then predicted and the certainty of the classification was calculated. Given a training set of expression vectors (of values across metagenes) representing two biological states, a binary probit regression model, of predictive probabilities for each of the two states (resistant vs. sensitive) for each case is estimated using Bayesian methods. Predictions of the relative oncogenic pathway status and chemosensitivity of the validation cell lines or tumor samples are then evaluated using methods previously described36'bo producing estimated relative probabilities - and associated measures of uncertainty - of chemosensitivity/oncogenic pathway deregulation across the validation samples. In instances where a combined probability of sensitivity to a combination chemotherapeutic regimen was required based on the individual drug sensitivity patterns, we employed the theorem for combined probabilities as described by Feller: [Probability (Pr) of (A), (B), (C).....(N)] = EPr (A) + Pr (B) + Pr (C).....+ Pr (N) - [Pr(A) x Pr(B) x Pr(C).....x Pr (N)].
Hierarchical clustering of tumor predictions was performed using Gene Cluster 3Ø 63 Genes and tumors were clustered using average linkage with the uncentered correlation similarity metric. Standard linear regression analyses and their significance (log rank test) were generated for the drug response data and correlation between drug response and probability of chemosensitivity/pathway deregulation using GraphPad software.

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Table 1. The genes constituting the individual chemosensitivity predictors.
5-FU Predictor- Metagene 1 Probe Set ID Gene Title Gene Symbol 151_s_at "hypothetical gene LOC92755 /lI tubulin, beta Ill similar to LOC92755 /// TUBB lll tubulin, beta 5" LOC648765 1713_s_at "cyclin-dependent kinase inhibitor 2A (melanoma, p16, CDKN2A
inhibits CDK4)"
1882 at --- ---31322 at T cell receptor alpha locus TRA
31726 at " amma-aminobu ric acid (GABA) A receptor, alpha 3" GABRA3 32308 r at "colla en, type I, alpha 2" COL1A2 32318 s at "actin, beta" ACTB ?
32610 at PDZ and LIM domain 4 PDLIM4 32755 at "actin, alpha 2, smooth muscle, aorta" ACTA2 33437 at FtsJ homolog 1 E. coli) FTSJ1 33444_at neighbor of BRCA1 gene 1/// similar to neighbor of BRCA1 NBR1 ///

genel 33659 at cofilin 1 (non-muscle) CFL1 34377 at "ATPase, Na+/K+ trans ortin , alpha 2+ ol e tide" ATP1A2 34454 r at a oli o rotein C-IV APOC4 34545 at KIAA1509 KIAA1509 34843 at zinc finger protein 516 ZNF516 34905 at " lutamate receptor, ionotro ic, kainate 5" GRIK5 34954 r at " hos hodiesterase 5A, cGMP-specific" PDE5A
35056 at arylsulfatase F ARSF
35144 at zinc finger CCCH-type containing 7B ZC3H7B
35213 at WW domain binding protein 4 (formin binding protein 21) WBP4 35816 at c statin B (stefin B) CSTB
35929_s_at "testis specific protein, Y-linked 1/// testis specific protein, TSPY1 lll TSPY2 ///
Y-linked 2/Il similar to testis specific protein, Y-linked 1 IlI LOC653174 /lI
similar to testis specific protein, Y-linked 1 lll similar to testis LOC728132 specific protein, Y-linked 1/// similar to testis specific LOC728137 IlI
protein, Y-linked 1/// similar to testis specific protein, Y- LOC728395 ///
linked 1/// similar to testis specific protein, Y-linked 1" LOC728403 lll 36245 at 5-h drox tamine (serotonin) receptor 2B HTR2B
36453 at kelch repeat and BTB (POZ) domain containing 11 KBTBD11 36549_at "solute carrier family 25 (mitochondrial carrier; peroxisomal membrane protein, 34kDa), member 17"
37349 r at high mobility group nucleosomal binding domain 3 HMGN3 37361 at fibroblast growth factor (acidic) intracellular binding protein FIBP
37437 at intraflagellar transport 140 homolog Chlam domonas IFT140 37802 r at "family with sequence similarity 63, member B" FAM63B
37860 at zinc finger protein 337 ZNF337 39783 at KIAA0100 KIAA0100 39898 at "family with sequence similari 13, member C1" FAM13C1 40104 at "serine/threonine kinase 25 STE20 homolog, yeast)" STK25 40452 at copine I CPNE1 40471 at peroxisomal biogenesis factor 19 PEX19 40536 f at Eukaryotic translation initiation factor 5B EIF5B
40886_at eukaryotic translation elongation factor 1 alpha 1/// EEF1A1 ///
APOLD1 lll apolipoprotein L domain containing 1 lll similar to eukaryotic LOC440595 translation elongation factor 1 alpha 1 40983 s at serine racemase SRR
41058 at thioesterase superfamily member 2 THEM2 41536_at "Inhibitor of DNA binding 4, dominant negative helix-loop- ID4 helix protein"
41868_at gamma-glutamyltransferase 1/// gamma- GGT1 /// GGTL4 glutamyltransferase-like 4 427 f at "interferon, alpha 10" IFNA10 429 f at "tubulin, beta 2A IlI tubulin, beta 4/// tubulin, beta 2B" TUBB2A IlI
TUBB4 lll 1071-9276I.DOC TUBB2B
471 f at "tubulin, beta 3" TUBB3 Adriamycin Predictor - Metagene 2 Probe Set ID Gene Title Gene Symbol 1051 at melan-A MLANA
110 at chondroitin sulfate proteoglycan 4 (melanoma-associated) CSPG4 1319 at "discoidin domain receptor family, member 2" DDR2 1519_at v-ets erythroblastosis virus E26 oncogene homolog 2 ETS2 (avian) 1537_at "epidermal growth factor receptor (erythroblastic leukemia EGFR
viral (v-erb-b) oncogene homolog, avian)"
2011 s at BCL2-interacting killer a o tosis-inducin BIK
266 s at CD24 molecule CD24 32139 at zinc finger protein 185 (LIM domain) ZNF185 32168 s at Down syndrome critical region gene 1 DSCR1 32612 at " gelsolin (amyloidosis, Finnish type)" GSN
32718 at t ros I rotein sulfotransferase 1 TPST1 32821 at lipocalin 2 (oncogene 24p3) LCN2 32967 at Fas a o totic inhibitory molecule 3 FAIM3 33004 at NCK adaptor protein 2 NCK2 33240 at PDZ domain containing RING finger 3 PDZRN3 33409 at "FK506 binding protein 2, 13kDa" FKBP2 33824 at keratin 8 KRT8 33853 s at neuropilin 2 NRP2 33892 at plakophilin 2 PKP2 33904 at claudin 3 CLDN3 33908 at "cal ain 1, mu/I large subunit" CAPN1 33942 s at syntaxin binding protein 1 STXBP1 33956 at I m hoc e antigen 96 LY96 34213 at WW and C2 domain containing 1 WWC1 34303 at chromosome 10 open reading frame 56 ClOorf56 34348 at "serine peptidase inhibitor, Kunitz type, 2" SPINT2 34859 at "melanoma antigen family D, 2" MAGED2 34885 at s na to rin 2 SYNGR2 34993_at "sarcoglycan, delta (35kDa dystrophin-associated SGCD
glycoprotein)"
35280 at "laminin, gamma 2" LAMC2 35444 at chromosome 19 open reading frame 21 C19orF21 35681 r at zinc finger homeobox 1b ZFHXIB
35766 at keratin 18 KRT18 35807 at "c ochrome b-245, alpha polypeptide" CYBA
36133 at desmoplakin DSP
36618_g_at "inhibitor of DNA binding 1, dominant negative helix-loop- ID1 helix protein" 36619_r at "inhibitor of DNA binding 1, dominant negative helix-loop- ID1 helix protein"
36795_at prosaposin (variant Gaucher disease and variant PSAP
metachromatic leukod stro h 36828 at zinc finger pmtein 629 ZNF629 36849 at Rho GTPase activating protein 29 ARHGAP29 37117 at Rho GTPase activating protein 8/// PRR5-ARHGAP8 fusion ARHGAP8 IlI

37251 s at I co rotein M6B GPM6B
37327_at "epidermal growth factor receptor (erythroblastic leukemia EGFR
viral (v-erb-b) oncogene homolog, avian)"
37345 at calumenin CALU
37552 at " potassium channel, subfamily K, member 1" KCNK1 37695 at ring finger protein 144 RNF144 37743 at fasciculation and elongation protein zeta I (zygin I FEZ1 37749 at mesoderm specific transcri t homolog (mouse) MEST
37926 at Kruppel-like factor 5 (intestinal) KLF5 38004 at chondroitin sulfate proteoglycan 4 (melanoma-associated) CSPG4 38078 at "filamin B, beta (actin binding protein 278)" FLNB
I co horin C (Gerbich blood group) GYPC
38122 at "solute carrier family 23 (nucleobase trans orters , member SLC23A2 2"
38227 at microphthalmia-associated transcri tion factor MITF
38297_at "phosphatidylinositol transfer protein, membrane-associated PITPNM1 38379 at I co rotein (transmembrane) nmb GPNMB
38653 at peripheral myelin protein 22 PMP22 ;. .
39214 at plexin B3 /// SFRS protein kinase 3 PLXNB3 SRPK3 39271 at melanoma inhibitory activity MIA
39316 at "RAB40C, member RAS oncogene family" RAB40C
39386 at MAD2L1 binding protein MAD2L1 BP
39801 at " procollagen-lysine, 2-oxoglutarate 5-dioxygenase 3" PLOD3 40103 at villin 2 (ezrin) VIL2 40202 at Kruppel-like factor 9 KLF9 40434 at podocalyxin-like PODXL
40568_at "ATPase, H+ transporting, lysosomal 56/58kDa, V1 subunit ATP6V1 B2 B2"
40926_at "solute carrier family 6 (neurotransmitter transporter, SLC6A8 creatine), member 8"
41158_at "proteolipid protein 1(Pelizaeus-Merzbacher disease, PLP1 spastic ara le ia 2, uncom licated "
41294 at keratin 7 KRT7 41359 at plakophilin 3 PKP3 ---41378 at MRNA from chromosome 5 31-33 region 41453 at "discs, large homolog 3 neuroendocrine-dl , Droso hila " DLG3 41503 at zinc fingers and homeoboxes 2 ZHX2 41610 at "laminin, alpha 5" LAMA5 41644 at SAM and SH3 domain containing 1 SASH1 41839 at growth arrest-specific 1 GAS1 575 s at tumor-associated calcium signal transducer 1 TACSTD1 661 at growth arrest-specific 1 GAS1 953 at ---999 at "c ochrome P450, family 27, subfamily A, polypeptide 1" CYP27A1 Cytotoxan Predictor- Metagene 3 Probe Set ID Gene Title Gene Symbol 1356 at death associated protein 3 DAP3 31511 at ribosomal protein S9 RPS9 32252 at "transthyretin (prealbumin, amyloidosis type I" TTR
32318 s at "actin, beta" ACTB
32434 at m risto lated alanine-rich protein kinase C substrate MARCKS
32893_s_at gamma-glutamyltransferase 1/// gamma- GGT1 /// GGT2 /// GGTL4 glutamyltransferase 2/// gamma-glutamyltransferase-like 4 GGTLA4 /// LOC643171 gamma-glutamyltransferase-like activity 4/// similar to /// LOC653590 Gamma-glutamyltranspeptidase 1 precursor (Gamma- LOC728226 lll glutamyltransferase 1) (CD224 antigen) /// similar to LOC728441 IlI
gamma-glutamyltransferase 2/// similar to gamma- LOC729838 ///
glutamyltransferase 2/// similar to Gamma- LOC731629 glutamyltranspeptidase 1 precursor (Gamma-glutamyltransferase 1) (CD224 antigen) /// similar to gamma-glutamyltransferase-like 4 isoform 2/// similar to amma- lutam Itransferase-like 4 isoform 2 33145 at "Fanconi anemia, complementation group A" FANCA
33362 at CDC42 effector protein (Rho GTPase binding) 3 CDC42EP3 33919 at tetraspanin 4 TSPAN4 34246 at chromosome 6 open reading frame 145 C6orf145 35352 at a I-h drocarbon receptor nuclear translocator 2 ARNT2 356_at kinesin family member 22 lll similar to Kinesin-like protein KIF22 ///

KIF22 (Kinesin-like DNA-binding protein) (Kinesin-like protein 4) 35763 at neurobeachin-like 2 NBEAL2 36119 at "caveolin 1, caveolae protein, 22kDa" CAV1 ~= .
secernin 1 SCRN1 36536 at schwannomin interacting protein 1 SCHIP1 37375 at " leckstrin homology-like domain, family B, member 1" PHLDB1 37680 at A kinase (PRKA) anchor protein (gravin) 12 AKAP12 37745 s at suppression of tumori enici 5 ST5 38288 at snail homolog 2 Droso hila SNA12 38375 at esterase D/form I lutathione hydrolase ESD
38479 at "acidic (leucine-rich) nuclear phosphoprotein 32 family, ANP32B
member B"
39170 at "CD59 molecule, complement re ulato protein" CD59 39329 at "actinin, alpha 1" ACTN1 39351 at "CD59 molecule, complement re ulato protein" CD59 39696 at paternally expressed 10 PEG10 39750 at "CDNA FLJ25106 fis, clone CBR01467" ---40213_at "SWI/SNF related, matrix associated, actin dependent SMARCAI
regulator of chromatin, subfamily a, member 1"
40394 at amma lutam I carboxylase GGCX
40855 at sterile alpha motif domain containing 4A SAMD4A
40953 at "cal onin 3, acidic" CNN3 41195_at LIM domain containing preferred translocation partner in LPP
lipoma 41403 at small nuclear ribonucleo rotein ol e tide F SNRPF
41449 at "sarco I can, epsilon" SGCE
41739 s at caldesmon 1 CALD1 41758 at chromosome 22 open reading frame 5 C22orf5 Docetaxel Predictor - Metagene 4 Probe Set ID Gene Title Gene Symbol 1003_s_at "Burkitt lymphoma receptor 1, GTP binding protein BLR1 (chemokine (C-X-C mo ' receptor 5)"
1420 s at "euka otic translation initiation factor 4A, isoform 2" EIF4A2 1567_at fms-related tyrosine kinase 1(vascutar endothelial growth FLT1 factor/vascutar permeability factor rece tor 1861 at BCL2-anta onist of cell death BAD
32085_at "phosphatidytinositol-3-phosphate/phosphatidylinositol5- PIP5K3 kinase, type III"
32218_at "CDNA: FLJ22515 fis, clone HRC12122, highly similar to AF052101 Homo sapiens clone 23872 mRNA sequence"
32238 at brid in integrator 1 BIN1 32340 s at Y box binding protein 1 YBX1 32828 at branched chain ketoacid deh dro enase kinase BCKDK
33176 at deox h usine h dro lase/monoox enase DOHH
33204 at Forkhead box Dl FOXD1 33388 at testis expressed sequence 261 TEX261 33444_at neighbor of BRCA1 gene 1/// similar to neighbor of BRCA1 NBR1 ///

ene 1 34523 at a oli o rotein A-IV APOA4 34647 at DEAD As -Glu-Ala-As box polypeptide 5 DDX5 34773 at tubulin folding cofactor A TBCA
34801 at ubi uitin specific pepfidase 52 USP52 34804 at "Solute carrier family 25, member 36" SLC25A36 35018 at calcium binding protein P22 CHP
35655 at ank rin repeat domain 28 ANKRD28 35714 at " ridoxal (py(idoxine, vitamin 136) kinase" PDXK
35770 at "ATPase, H+ trans ortin , lysosomal accessory protein 1" ATP6AP1 35815 at SET domain containing 2 SETD2 36068 at copper chaperone for su eroxide dismutase CCS
36209 at bromodomain containing 2 BRD2 36250 at aspartate beta-h drox lase domain containing I ASPHDI
36366_at "UDP-Gal:betaGlcNAc beta 1,4- galactosyltransferase, B4GALT6 ol e tide 6"
36395 at Transcribed locus -argininosuccinate lyase ASL
36641 at "ca in protein (actin filament) muscle Z-line, alpha 2" CAPZA2 37355 at START domain containing 3 STARD3 38618_at "LIM domain kinase 2/// protein phosphatase 1, regulatory LIMK2 ///

(inhibitor) subunit 14B pseudogene 1"
38663 at barrier to autointegration factor 1 BANF1 38831_f at "guanine nucleotide binding protein (G protein), beta GNB2 ol e tide 2"
39012 at endosulfine alpha ENSA
39159 at SH3-domain GRB2-like 1 SH3GL1 39199 at activin A receptor, type IB" ACVR1B
39599_at "solute carrier family 6(neurotransmitter transporter, SLC6A1 GABA), member 1"
40867_at "protein phosphatase 2 (formerly 2A), regulatory subunit A PPP2R1A
(PR 65), alpha isoform"
41063 at ol comb group dng finger 1 PCGF1 41077 at hypothetical protein LOC643641 L0C643641 41285 at "inositol polyphosphate-5-phosphatase, 40kDa" INPP5A
41489_at "transducin-like enhancer of split 1(E(sp1) homolog, TLE1 Droso hila "
41689 at plasma membrane proteolipid lasmoli in PLLP
41713 at zinc finger with KRAB and SCAN domains 1 ZKSCANI
41762_at TIA1 cytotoxic granule-associated RNA binding protein-like TIAL1 910 at "thymidine kinase 1, soluble" TK1 922_at "protein phosphatase 2 (formerly 2A), regulatory subunit A PPP2RIA
(PR 65), alpha isoform"
941 at " proteasome (prosome, macro ain subunit, beta type, 6" PSMB6 954 s at -- --Etoposide Predictor - Metagene 5 Probe Set ID Gene Title Gene Symbol 1015 s at LIM domain kinase 1 LIMK1 1188 at "ligase III, DNA, ATP-dependent" LIG3 1233 s at AXL receptor tyrosine kinase AXL
1456 s at "interferon, gamma-inducible protein 16" IF116 160020 at matrix metallo e tidase 14 (membrane-inserted) MMP14 1680 at growth factor receptor-bound protein 7 GRB7 1704 at vav 2 onco ene VAV2 1963_at fms-related tyrosine kinase 1 (vascular endothelial growth FLT1 factor/vascular permeability factor rece tor 2047 s at junction plakoglobin JUP
296 at --- --297 at ---311 s at --- ---31719 at fibronectin 1 FN1 31720 s at fibronectin 1 FN1 32378 at ruvate kinase, muscle" PKM2 32387 at I so hos holi ase 3 (lysosomal phospholipase A2) LYPLA3 32593 at "raftlin, lipid raft linker 1" RFTN1 33282 at ladinin 1 LAD1 33448 at "serine peptidase inhibitor, Kunitz type 1" SPINT1 33904 at claudin 3 CLDN3 34320 at polymerase I and transcri t release factor PTRF
34348 at "serine peptidase inhibitor, Kunitz type, 2" SPINT2 34747 at matrix metallo e tidase 14 (membrane-inserted) MMP14 34769 at fattacid amide hydrolase FAAH
35276 at claudin 4 CLDN4 35309 at suppression of tumodgenicity 14 (colon carcinoma) ST14 35444 at chromosome 19 open reading frame 21 C19orf21 35541 r at KIAA0506 protein KIAA0506 35630 at lethal giant larvae homolog 2 (Drosophila) MAP-kinase LLGL2 MADD
~ activating death domain 10-74 356 9 at . cordon-bleu homolog (mouse) COBL

35681 r at zinc finger homeobox 1 b ZFHX1 B
35735 at " uan late binding protein 1, interferon-inducible, 67kDa" GBPI 36097 at immediate earl response 2 IER2 36890 at periplakin PPL
37934 at transmembrane protein 30B TMEM30B
38221 at connector enhancer of kinase suppressor of Ras 1 CNKSRI
38482 at claudin 7 CLDN7 38759 at "bu ro hilin, subfamily 3, member A2" BTN3A2 38760 f at "bu ro hilin, subfamily 3, member A2" BTN3A2 39331 at "tubulin, beta 2A" TUBB2A
39732 at microtubule-associated protein 7 MAP7 39870 at Testes-specific heterogenous nuclear ribonucleo rotein G-T HNRNPG-T
40215 at UDP-glucose ceramide glucosyltransferase UGCG
40225 at cyclin G associated kinase GAK
41359 at plakophilin 3 PKP3 41872 at "deafness, autosomal dominant 5" DFNA5 479_at "disabled homolog 2, mitogen-responsive phosphoprotein DAB2 Droso hila "
575 s at tumor-associated calcium signal transducer 1 TACSTD1 671 at "secreted protein, acidic, c steine-rich (osteonectin)" SPARC
903_at "protein phosphatase 2, rogulatory subunit B (B56), alpha PPP2R5A
isoform"

Taxol Predictor - Metagene 6 Probe Set ID Gene Title Gene Symbol 1218 at nuclear receptor subfamily 2, group F, member 6 NR2F6 1581 s at topoisomerase (DNA) II beta 180kDa TOP2B
1587 at retinoic acid receptor, gamma RARG
1824 s at proliferating cell nuclear antigen PCNA
1871_g_at protein tyrosine phosphatase, non-receptor type 11 (Noonan PTPN11 syndrome 1) 1882 at -- -1903 at --- ---2001_g_at ataxia telangiectasia mutated (includes complementation ATM
groups A, C and D) 249at nuclear factor of activated T-cells, cytoplasmic, calcineurin- NFATC4 de endent 4 32386 at MRNA full length insert cDNA clone EUROIMAGE 117929 33064 at calcium channel, volta e-de endent, gamma subunit 1 CACNGI
33557 at chromosome 22 open reading frame 31 C22orf31 335 r at 34197 at hos hoinositide-3-kinase re ulato subunit 2 (p85 beta) PIK3R2 34247 at Protease, serine, 12 neurot sin moto sin PRSS12 34471 at m osin heavy chain 8, skeletal muscle, perinatal MYH8 34862 at saccharopine deh dro enase (putative) SCCPDH
34909 at putative homeodomain transcri tion factor 2 PHTF2 34923 at IQ motif and Sec7 domain 2 IQSEC2 34984_at transient receptor potential cation channel, subfamily C, TRPC3 member 3 35254 at TRAF-type zinc finger domain containing 1 TRAFDI
35644 at hephaestin HEPH
35908 at SRY (sex determining region Y box 30 SOX30 36595_s_at glycine amidinotransferase (L-arginine:glycine GATM
amidinotransferase) 37378 r at lamin A/C LMNA
37767 at huntingtin Huntin ton disease) HD
38680 at --- ---38697 at Yipl domain family, member 3 YIPF3 38703 at aspartyl amino e tidase DNPEP
39488 at Protocadherin 9 PCDH9 39537 at kelch domain containing 3 KLHDC3 ~FQ~t~ pp~ solute carrier family 10 (sodium/bile acid cotransporter family), member 3 40529 at LIM homeobox 2 LHX2 40690 at CDC28 protein kinase re ulato subunit 2 CKS2 41045 at secreted and transmembrane 1 SECTMI
41204 s at s licin factor 1 SF1 41404 at ribosomal protein S6 kinase, 90kDa, polypeptide 4 RPS6KA4 761_g_at dual-specificity tyrosine-(Y)-phosphorylation regulated kinase DYRK2 777 at GDP dissociation inhibitor 2 GDI2 925 at interferon, gamma-inducible protein 30 IF130 Topotecan Predictor - Metagene 7 Probe Set ID Gene Title Gene Symbol 1005 at dual s ecificit phosphatase 1 DUSP1 115 at thrombos ondin 1 THBSI
1233 s at AXL receptor tyrosine kinase AXL
1251 at RAP1 GTPase activating protein RAP1 GAP
1257 s at uiescin Q6 QSCN6 1278 at -- --1368 at "interleukin I rece tor type I" IL1 R1 1385 at "transforming growth factor, beta-induced, 68kDa" TGFBI
1491 at " pentraxin-related gene, ra idl induced by IL-1 beta" PTX3 1544 at Bloom syndrome BLM
1563 s at "tumor necrosis factor receptor su erFamil , member 1A" TNFRSFIA
1593 at fibroblast growth factor 2 (basic) FGF2 159 at vascular endothelial growth factor C VEGFC
160044 at "aconitase 2, mitochondrial" ACO2 1751_g at " hen lalanine-tRNA s nthetase-like alpha subunit" FARSLA
1783 at Ras and Rab interactor 2 RIN2 1828 s at fibroblast growth factor 2 (basic) FGF2 1879 at related RAS viral (r-ras) oncogene homolog RRAS
1958 at c-fos induced growth factor (vascular endothelial growth FIGF
factor D
2042 s at v-m b myeloblastosis viral onco ene homolog (avian) MYB
2053 at "cadherin 2, type 1, N-cadherin (neuronal)" CDH2 2056_at "fibroblast growth factor receptor 1 (fms-related tyrosine FGFR1 kinase 2, Pfeiffer s ndrome "
2057_g_at "fibroblast growth factor receptor 1(frns-related tyrosine FGFR1 kinase 2, Pfeiffer s ndrome "
232 at "laminin, gamma I (formerly LAMB2 " LAMCI
31521 f at "histone cluster 1, H4k /// histone cluster 1, H4j" HIST1 H4K ///

32098 at "colla en, type VI, alpha 2" COL6A2 32116 at transmembrane channeNike 6 TMC6 32260 at hos ho rotein enriched in astrocytes 15 PEA15 32434 at m risto lated alanine-rich protein kinase C substrate MARCKS
32529 at c oskeleton-associated protein 4 CKAP4 32531 at "gap junction protein, alpha 1, 43kDa connexin 43)" GJA1 32535 at fibrillin 1 FBN1 32606 at "Brain abundant, membrane attached signal protein 1" BASP1 32607 at "brain abundant, membrane attached signal protein 1" BASP1 32673 at "but ro hilin subfamily 2, member A1" BTN2A1 32808_at "integrin, beta 1(fibronectin receptor, beta polypeptide, ITGB1 anti en CD29 includes MDF2, MSK12)"
32812 at h othetical protein DKFZP686A01247 32847 at "m osin, light chain kinase" MYLK
33127 at i s I oxidase-like 2 LOXL2 33328 at HEG homolog 1 (zebrafish) HEGI
33337_at "degenerative spermatocyte homolog 1, lipid desaturase DEGS1 Droso hila "
33404 at "CAP, adenylate clase-associated protein, 2 east " CAP2 33405 at "CAP, adenylate cyclase-associated protein, 2 (yeast)" CAP2 33772 at prostaglandin E receptor 4 (subtype EP4) PTGER4 33785 at brain-s ecific an io enesis inhibitor 2 BAI2 33787 at "NUAK family, SNF1-like kinase, 1" NUAK1 33791_at "deleted in lymphocytic leukemia, 1/// SPANX family, DLEU1 /// SPANXC
member C"
33882 at RAB11 family interacting protein 5 (class I RAB11FIP5 33900 at follistatin-like 3 (secreted glycoprotein) FSTL3 33994_g_at "myosin, light chain 6, alkali, smooth muscle and non- MYL6 muscle"
34091 s at vimentin VIM
34106 at guanine nucleotide binding protein (G protein) alpha 12 GNA12 34318 at "PRAl domain family, member 2" PRAF2 34320 at polymerase I and transcript release factor PTRF
34375 at chemokine (C-C motif) ligand 2 CCL2 34795 at " procoliagen-lysine, 2-oxoglutarate 5-dioxygenase 2" PLOD2 34802 at "colla en, type VI, alpha 2" COL6A2 34811_at "ATP synthase, H+ transporting, mitochondrial FO complex, ATP5G3 subunit C3 (subunit 9)"
35130 at glutathione reductase GSR
35264_at "NADH dehydrogenase (ubiquinone) Fe-S protein 3, 30kDa NDUFS3 (NADH-coenzyme Q reductase)"
35309 at suppression of tumori enici 14 (colon carcinoma) ST14 35366 at nidogen 1 NID1 35729 at myosin ID MYO1 D
35751_at "succinate dehydrogenase complex, subunit B, iron sulfur SDHB
I "
36119 at "caveolin 1, caveolae protein, 22kDa" CAV1 36149 at dih dro rimidinase-like 3 DPYSL3 36369 at polymerase I and transcript release factor PTRF
36525 at F-box and leucine-rich repeat protein 2 FBXL2 36550 at Ras and Rab interactor 2 RIN2 36577at "pleckstrin homology domain containing, family C (with PLEKHC1 FERM domain) member 1"
36638 at connective tissue growth factor CTGF
36659 at "colla en, type IV, alpha 2" COL4A2 36790 at tro om osin 1 al ha TPM1 36791 at tro om osin 1 al ha TPM1 36792 at tro om osin 1 al ha TPM1 36799 at frizzled homolog 2 Droso hila FZD2 36811 at I s I oxidase-like 1 LOXLI
36885 at spleen tyrosine kinase SYK
36952_at "hydroxyacyl-Coenzyme A dehydrogenase/3-ketoacyl- HADHA
Coenzyme A thiolase/enoyl-Coenzyme A hydratase (trifunctional protein), alpha subunit"
36988_at "tumor necrosis factor, alpha-induced protein 1 TNFAIP1 (endothelial)" 37032 at nicotinamide N-methyltransferase NNMT
37322 s at h drox rosta landin deh dro enase 1 5- NAD HPGD
37408 at "mannose receptor, C type 2" MRC2 37486 f at Meis1 homolog 3 (mouse) pseudogene 1 MEIS3P1 37599 at aldehyde oxidase 1 AOX1 376_at "sema domain, immunoglobulin domain (Ig), short basic SEMA3C
domain, secreted, sema horin 3C"
377_g_at "sema domain, immunoglobulin domain (Ig), short basic SEMA3C
domain, secreted, sema horin 3C"
38113 at "s ectrin repeat containing, nuclear envelope 1" SYNE1 38125_at "serpin peptidase inhibitor, clade E (nexin, plasminogen SERPINE1 activator inhibitor type 1), member 1"
38299 at "inter{eukin 6 (interferon, beta 2)" IL6 38338 at related RAS viral (r-ras) oncogene homolog RRAS
38394 at I cerol-3 hos hate deh dro enase 1-like GPD1 L
--38396 at 3'UTR of hypothetical protein (ORF1) 38433 at AXL receptor tyrosine kinase AXL
WD re eat domain 23 WDR23 38482 ~t claudin 7 CLDN7 38488 s at interleukin 15 IL15 38631 at "tumor necrosis factor, alpha-induced protein 2" TNFAIP2 38772 at "c steine-rich, an io enic inducer, 61" CYR61 38775_at low density lipoprotein-related protein 1 (alpha-2- LRP1 macroglobulin rece tor 38842 at an iomotin like 2 AMOTL2 :.' 38921 at " phosphodiesterase 1 B, calmodulin-dependent" PDE1 B
39100_at "sparc/osteonectin, cwcv and kazal-like domains SPOCK1 proteoglycan (testican) 1"
39254 at retinoic acid induced 14 RAI14 39277 at -- -' 39327 at peroxidasin homolog Droso hila PXDN
39333 at "colla en, type IV, alpha 1" COL4A1 39409 at "com lement component 1, r subcomponent" C1 R
39614 at KIAA0802 //! chromosome 21 open reading frame 57 KIAA0802 ///
C21orf57 39710 at chromosome 5 open reading frame 13 C5orf13 39867 at "Tu translation elongation factor, mitochondrial" TUFM
39901 at EGF-like repeats and discoidin I-like domains 3 EDIL3 40023 at brain-derived neurotrophic factor BDNF
40078 at " protease, serine, 23" PRSS23 40096_at "ATP synthase, H+ transporting, mitochondrial Fl complex, ATP5A1 alpha subunit 1, cardiac muscle"
40171 at frequently rearranged in advanced T-cell I m homas 2 FRAT2 40341 at chromosome 16 open reading frame 51 C16orf51 40497 at tumor suppressor candidate 4 _ TUSC4 40564 at nucleo orin 50kDa NUP50 40567 at "tubulin, alpha 3" TUBA3 40642 at nuclear factor I/B NFIB
40692_at "transducin-like enhancer of split 4(E(sp1) homolog, TLE4 Droso hila "
40781_at "V-akt murine thymoma viral oncogene homolog 3 (protein AKT3 kinase B, gamma)"
40936 at cysteine rich transmembrane BMP regulator 1 chordin-like CRIM1 41197 at RAD23 homolog A S. cerevisiae) RAD23A
41223 at cytochrome c oxidase subunit Va COXSA
41236_at "Smith-Magenis syndrome chromosome region, candidate SMCR7L
7-like"
41273 at matrix-remodelling associated 7 MXRA7 41295 at START domain containing 7 STARD7 41354 at stanniocalcin 1 STCI
41478 at tetratrico e ptid repeat domain 28 TTC28 41544 at polo-like kinase 2 Droso hila PLK2 41667 s at "TDP-glucose 4,6-dehydratase" TGDS
41738 at caldesmon 1 CALDI
41744 at optineurin OPTN
41745 at interferon induced transmembrane protein 3 (1-8U) IFITM3 41872 at "deafness, autosomal dominant 5" DFNA5 424_s_at "fibroblast growth factor receptor 1(fms-related tyrosine FGFR1 kinase 2, Pfeiffer s ndrome "
465 at "HIV-1 Tat interacting protein, 60kDa" HTATIP
548 s at spleen tyrosine kinase SYK
581 at "laminin, beta 1" LAMB1 628 at frizzled homolog 2 Droso hila FZD2 ;'.
672_at "serpin peptidase inhibitor, clade E (nexin, plasminogen SERPINE1 activator inhibitor type 1, member 1"
867 s at thrombospondin 1 THBS1 875 at chemokine (C-C moti ligand 2 CCL2 884_at "integrin, alpha 3 (antigen CD49C, alpha 3 subunit of VLA-3 ITGA3 rece tor "
885_g_at "integrin, alpha 3 (antigen CD49C, alpha 3 subunit of VLA-3 ITGA3 rece tor "
890 at ubi uitin-con'u atin enzyme E2A (RAD6 homolog) UBE2A
DOC

Table 2 Tumor data setl Response Actual OveraU response Genomic-based Prettiction oÃResponse e. PPV for Res ponse Breast Tumor Data = MDACC 13/5I (25.4%) 11113 (85.7%) = Adjuxrent 33145 (66.6%) 28J31 (9030h) = Neoadjuvswt Docetmcel 13/24 (54.1%) 11;13 (85.7%).
O~:~rian = Topotecan 20148 (41.694) 17122 (77.341) = Paclitaxel 2055 (57.1%) 20;28 (71.$9'b) = Docet:ixel 7,114(S09to) 6!7 (8$.796) Adtiamvcin (Evans et al) 24f122 (19.6%) 1963 (57.5%) ..

Table 3 ~..
V6dation51D Fopotecon Adrlemycla Etoposide 5-Floturossracil racUtaxel Cytoxan Dooetnstl In vilro Data = prnxiHcy 18/20 (90%) 18/25 (864i) 21124 (87%) 21ls.+4 (87%) 26128 (92.8%) 25129(86.2%) P<0.001 cY
= pPV 12114 (86Yo) 13/13 (100%) 618 (759"s) 14114(100Y=) 21121(1004u) 13/15 (86.614) = NPV 616 (100%) 518 (62:55b) 15116 (94%) 7110 (704b) 5/7 (71.5%) 12114 (864$) In vivo (Patient) Data east a"
= ,4cctuncy 40148 (83.32%) 991122 (81g'o) - -- 2855 (80 .8) -- 2224 (91.6%) 1211d (85.7%) e PPV 17,22 (7734-o) 19/33 (57.54='0) 20138 (71.a1b) 11113 (85.7%) 617 (85.7%) = NPV 23/26 (88.5 .c) 80129 (89.8 .0) 7/7 (1009'e) 11111 (100%) 6/7 (85:74b) PPV - positice predictir=ttialue, NPV - uegative predictive valuo, i,*Deterniiaing accuraey for tiu docetaxel predictor in the UC ce11 liae data set was not postible siace docetaxel was not one of tbe drogs sttrclied. Iustead, the docetaxel predictor was vulidated in two indepeudent cen line expaiuuuts, conelnting predicted probability of respouse to docetaxel in vitro with actual IC50 of docetax.el by cell liue (Pigure I C).

i=

rTable 4 Docetaxel predictor pocetaxel predictor Genomic predictor of response to Predictor of response to VasidatiostsJPredicten (Yotti et alj (Cbang et at)++ TFAC chemotherapy TFACehtmotberapy O~Ottl et a atztai et a+
Breast neoadjuiant data (Chaag et at) = Acnuncy 22/24 (91.6%) 87.5%
= PPV 11113 (83.7%) 92%
= PrpV 11111(100'/0) 83%
= AUC ofROC 0.97 0.96 ?4iD1iCC data (Pucztai et at) . Acnuncy 42/51 (82.39'0) 74%
~ PPV 11118=(61.19'+) 44%
~ NIYV 31/33 (94%) 93%
PPV =pocitive predicdve valne, NpV - negative predictive value, "Forbolb the Chang and Pusztei data, the actaal numbete oFprediated responden was n:ot avaiLtbie, put tLe predictive accncaciec. Also, the prediciive accuracy repotied for the Chang data is not ia an independent talidation, iastead it is.fer a leave.one otit uosa avlidaYGon.

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Claims (25)

1. A method of identifying an effective cancer therapy agent for an individual with a platinum-resistant tumor, compnsing:

a) Obtaining a cellular sample from the individual;

b) Analyzing said sample to obtain a first gene expression profile;

c) Comparing said first gene expression profile to a platinum chemotherapy responsivity predictor set of gene expression profiles to identify whether said individual will be responsive to a platinum-based therapy;

d) If said individual is an incomplete responder to platinum based therapy, then comparing the first gene expression profile to a set of gene expression profiles comprising at least 5 genes from Table 1 that is capable of predicting responsiveness to other cancer therapy agents;

thereby identifying whether said individual would benefit from the administration of one or more cancer therapy agents, wherein said cancer therapy agents are not platinum-based.

2. The method of claim 1 wherein the cellular sample is taken from a tumor sample.

3. The method of claim 1 wherein the cellular sample is taken from ascites.

4. The method of claim 1 wherein the cancer therapy agent is a salvage therapy agent.

5. The method of claim 4 wherein the salvage therapy agent is selected from the group consisting of topotecan, adriamycin, doxorubicin, cytoxan, cyclophosphamide, gemcitabine, etoposide, ifosfamide, paclitaxel, docetaxel, and taxol.

6. The method of claim 1 wherein the cancer therapy agent targets a signal transduction pathway that is deregulated.

7. The method of claim 6 wherein the cancer therapy agent is selected from the group consisting of inhibitors of the Src pathway, inhibitors of the E2F3 pathway, inhibitors of the Myc pathway, and inhibitors of the beta-catenin pathway.

8. The method of claim 1 further comprising:

e) Administering to said individual an effective amount of one or more of the cancer therapy agents that was identified in step (d);

thereby treating the individual with said cancer.

9. The method of claim 8 wherein the cancer therapy agent is a salvage agent.

10. The method of claim 9 wherein the salvage therapy agent is selected from the group consisting of topotecan, adriamycin, doxorubicin, cytoxan, cyclophosphamide, gemcitabine, paclitaxel, docetaxel, and taxol.

11. A gene chip for predicting an individual's responsivity to a salvage therapy agent comprising the gene expression profile of at least 5 genes selected from Table 1.

12. A kit comprising a gene chip for predicting an individual's responsivity to a salvage therapy agent comprising the gene expression profile of at least 5 genes selected from Table I
and a set of instructions for determining an individual's responsivity to salvage therapy agents.

13. A computer readable medium comprising gene expression profiles comprising at least 5 genes from any of Table 1.

14. A method for estimating the efficacy of a therapeutic agent in treating a subject afflicted with cancer, the method comprising:

a) Determining the expression level of multiple genes in a tumor biopsy sample from the subject;

b) Defining the value of one or more metagenes from the expression levels of step (a), wherein each metagene is defined by extracting a single dominant value using singular value decomposition (SVD) from a cluster of genes associated tumor sensitivity to the therapeutic agent; and c) Averaging the predictions of one or more statistical tree models applied to the values of the metagenes, wherein each model includes one or more nodes, each node representing a metagene, each node including a statistical predictive probability of tumor sensitivity to the therapeutic agent, wherein at least one of the metagenes comprises at least 3 genes in metagenes 1, 2, 3, 4, 5, 6, or 7, thereby estimating the efficacy of a therapeutic agent in a subject afflicted with cancer.

15. The method of claim 14, wherein step (c) comprises the use of binary regression models.

16. The method of claim 14, further comprising:

d) Administering to the subject an effective amount of a therapeutic agent estimated to be efficacious in step (c), thereby treating the subject afflicted with cancer.

17. The method of claim 14, wherein said tumor is selected from a breast tumor, an ovarian tumor, and a lung tumor.

18. The method of claim 14, wherein said therapeutic agent is selected from docetaxel, paclitaxel, topotecan, adriamycin, etoposide, fluorouracil (5-FU), and cyclophosphamide, or any combination thereof.

19. The method of claim 14, wherein the therapeutic agent is docetaxel and wherein the cluster of genes comprises at least 10 genes from a metagene selected from any one of metagenes 1 through 7.

20. The method of claim 14, wherein the cluster of genes comprises at least 3 genes.

21. The method of claim 14, wherein at least one of the metagenes is metagene 1, 2, 3, 4, 5, 6, or 7.

22. The method of claim 14, wherein the cluster of genes corresponding to at least one of the metagenes comprises 3 or more genes in common to metagene 1, 2, 3, 4, 5, 6, or 7.

23. The method of claim 14, wherein step (a) comprises extracting a nucleic acid sample from the sample from the subject.

24. The method of claim 14, wherein the expression level of multiple genes in the tumor biopsy sample is determined by quantitating nucleic acids levels of the multiple genes using a DNA microarray.

25. The method of claim 14, wherein at least one of the metagenes shares at least 50% of its defining genes in common with metagene 1, 2, 3, 4, 5, 6, or 7.