WO2013142393A1

WO2013142393A1 - Method and apparatus for collecting, transporting and maintaining live tumor specimens ex vivo

Info

Publication number: WO2013142393A1
Application number: PCT/US2013/032724
Authority: WO
Inventors: Alex MOROZOV
Original assignee: Hudson River Biolabs
Priority date: 2012-03-19
Filing date: 2013-03-17
Publication date: 2013-09-26

Abstract

Method and device for ex vivo preservation and analysis of tumor tissue biopsy sample are provided. The method comprises the steps of collecting tumor tissue from a patient, depositing said tumor tissue into a device comprising a microfluidic channel filled with supporting medium, and initiating flow of medium around the tumor tissue, whereby the tumor tissue is preserved alive ex vivo.

Description

Method and apparatus for collecting, transporting and maintaining live tumor specimens ex vivo

Technical Field

[0001] The invention relates generally to the field of medical diagnostics, and more specifically, to the field of predictive models in oncology.

Background of the Invention

[0002] The main modalities for the treatment of cancer include surgery, radiation therapy, and systemic therapy. Systemic therapy includes cytotoxic therapy, commonly referred to as chemotherapy, as well as biologic therapy, such as small molecule inhibitors and biologies. Systemic therapy is commonly administered when cancer has already formed overt metastases throughout the body, referred to as the metastatic setting. In this setting, systemic therapy is rarely curative. Thus, improved systemic therapies are greatly needed (Kamb et al., 2007).

[0003] In vitro chemo-sensitivity testing, also referred to as chemotherapy sensitivity and resistance assay (CSRA), is a diagnostic test in which a patient's tumor sample is treated ex vivo with a panel of anticancer therapies with the goal of deciding which therapy is most appropriate for the patient. This is particularly useful for clinical scenarios where multiple therapies are available to the patient, and each therapy is effective only in the minority of the patients, as is the case in metastatic breast cancer, metastatic colon cancer and metastatic lung cancer. Genetic markers are known which are used for selection of patients for some newer targeted agents, such as trastuzumab, imatinib, crizotinib, vemurafenib. However, even in marker-positive populations, responses are not universal. Furthermore, no patient selection strategies currently exist for cytotoxic chemotherapy which is effective in only a subset of patients, at the expense of exposing all patients to significant toxicity. By testing the tumor ex vivo, the patient can be spared the toxicity of ineffective chemotherapy while the most active agent is selected, akin to antibiotic sensitivity testing in the treatment of infectious diseases. By allowing only the most sensitive patients to be selected for each anticancer agent, in vitro chemosensitivity testing is expected to improve response rates and survival in patients as compared to patients treated according to traditional methods.

[0004] In vitro chemo-sensitivity testing has been an active area of investigation in oncology for decades. Multiple approaches have been attempted (Suggitt and Bibby, 2005). One well-studied method is the soft agar clonogenic assay. In this method, the tumor specimen from the patient is separated into individual cells either mechanically or enzymatically, and grown in soft agar. The number of colonies that develops is thought to be a measure of tumor growth potential. Reduction in the number of such colonies by a drug is taken as evidence of the drug's antitumor activity. This assay has been shown to be poorly predictive (Von Hoff and Hanauske, 2009). Another in vitro chemo-sensitivity testing method is the ChemoFx technique (Precision Therapeutics, Pittsburgh, PA). This method requires mincing of tumor specimens into minute fragments, followed by growth of such fragments in culture dishes to establish monolayer cultures. These cultures are subsequently used for drug testing ((Herzog et al, 2010); (Kornblith); US patents 8058025, 8039213, 7771963, 7678552, 7575868, 7501260, 7314731). Another in vitro chemosensitivity assay is the Histoculture Drug Response Assay (HDRA, Anticancer, Inc, San Diego, CA;). This assay involves growing tumor fragments in collagen matrix, treating with anticancer agents, and measuring the effect on total cell proliferation (Hoffman, 1998; US patents 5474909, 5726009). Yet another chemosensitivity testing modality involves implanting human tumor fragments into immunodeficient mice, in a method referred to as tumorgraft. The tumor fragments grow in mice and can be re-transplanted into new mice to generate multiple mice carrying tumor fragments

- ? - derived from a single patient sample. The mice are subsequently treated with a panel of drugs.

However, to date, none of the above methods have been shown to be acceptable for clinical use (Burstein et al., 2011).

[0005] The lack of success with development of an adequate in vitro chemo-sensitivity test may be due to the following reasons. (1) Disaggregation of tumor cells and growth in serum-containing medium on plastic leads to irreversible changes induced by the culture environment and lack of contact with supporting stromal cells. Such samples may have altered drug sensitivity compared to the original tumor. The same is likely true for tumor fragments grown in contact with matrix such as agar or collagen. (2) Recent data demonstrates that a large proportion of cells within the tumor are supporting stromal cells rather than malignant cells (Morozov et al., 2010; Quintana et al., 2008). Some stromal cells may proliferate in excessively in vitro, while others may not survive in culture. A successful in vitro chemosensitivity assay should distinguish the effect of the drug on true malignant cells from the effect on the stromal cells. Existing in vitro chemosensitivity approaches require disaggregation of the tumor fragment, leading to loss of cell-cell interactions, followed by culture on plastic, which leads to selective outgrowth or death of stromal components. Efficacy of anticancer agents is assessed on the entire sample, without discrimination between malignant cells and stromal cells. (3) Human tumors grown in mice quickly lose human stromal cells which are replaced with mouse stroma. Many human tumor specimens do not grow in mice at all. For those that do grow, genetic and other changes accumulate over time, and the tumors therefore may respond differently to therapy than the tumor carried by the patient. In addition, the mouse is a poor delivery vessel for anticancer therapies. Drugs may be metabolized or distributed differently in mice than in humans. The tolerance of the mouse host may be lower, in which case drug concentrations appropriate for human use cannot be achieved in the mouse. Another problem with mouse-based predictive models is that many thousands of animals are

- ^ - often necessary. A single drug tested in a single patient sample may require more than 20 mice. As the number of drugs and tumor models increases, and especially if drug combinations are tested, the number of mice needed grows exponentially. The mouse is a mammal, and efforts are under way to develop predictive models that do not rely on animal testing.

[0006] In contrast to in vitro chemo-sensitivity testing, neoadjuvant systemic therapy is often referred to as "in vivo chemo-sensitivity testing" (von Minckwitz et al., 2005). In this approach, systemic therapy is given to the patient who does not yet have overt metastatic disease, but only has a primary tumor in place, with the goal of facilitating surgery and improving the odds of cure. A biopsy specimen is obtained first to establish the diagnosis, followed by a course of neoadjuvant chemotherapy, followed by resection of the tumor. Pathological examination is performed comparing the pre-treatment biopsy to the post-chemotherapy resection specimen to assess the effect of chemotherapy on the tumor. "Pathological complete response" (pCR) is defined as the absence of remaining malignant cells after neoadjuvant therapy. Thus, pathological techniques for assessing the effect of systemic therapy on the tumor are well-established. Pathologists can easily distinguish stromal cells from malignant cells, as well as live malignant cells from those killed by chemotherapy. In contrast, current in vitro chemo- sensitivity testing techniques require mechanical or enzymatic separation of the tumor specimen which makes histological examination of the specimen impossible.

[0007] Microfluidics is an area of bioengineering related to the flow of liquid in small channels. Applications of microfluidics in oncology have been described (Wlodkowic and Cooper, 2010). Many published reports describe techniques for growing cancer cell lines in microfluidics devices, which allow controlled flow of supporting medium with defined oxygen tension, and can be fabricated in complex geometries. US patent 6,849,424 (Deisboeck et al.) describes a microfluidics device for growing cancer cell lines and studying the mechanisms of tumor spread. However, the use of microfluidics devices to maintain surgical tumor specimens ex vivo has not been previously described.

[0008] Accordingly, there is a need for a device and method that will allow tumor specimens from patients to be maintained alive ex vivo, without mechanical or enzymatic disruption of the specimen, without the use of an animal host, so that the specimen may be treated with drugs ex vivo and analyzed histologically to assess drug effect.

Summary of the Invention

[0009] The device and method of the present invention solve the above problems of predictive assays in oncology.

[0010] The present invention provides, in one aspect, a live tumor specimen maintenance device (LTSMD) comprising a channel. The channel is filled with support medium. The device also comprises an apparatus to cause the flow of medium through the channel unidirectionally, so that fresh medium is continuously supplied to the tumor specimen.

[0011] In another aspect, the channel may have the internal dimensions to fit a core biopsy sample, while allowing sufficient space between the tissue sample and the walls of the channel to allow unimpeded flow of supporting medium.

[0012] In another aspect, the channel is composed of non-adherent material to prevent the biopsy specimen from adhering to the walls of the channel.

[0013] The present invention provides, in another aspect, a method comprising the steps of collecting tumor tissue from the patient, depositing said tumor tissue into said live tumor maintenance device, and initiating flow of medium around the tumor tissue, to preserve the tumor tissue alive ex vivo.

- - [0014] In another aspect, the tumor tissue is collected by performing a core needle biopsy.

[0015] In another aspect, the live tumor specimen maintenance device further comprises a core biopsy needle and a means of delivering the core biopsy specimen from the needle into the channel, together forming a live tumor specimen collection and maintenance device.

[0016] The present invention provides, in another aspect, a method comprising the steps of collecting a core biopsy specimen from a patient using a live tumor specimen collection and

maintenance device, transferring the sample from the needle into the channel, and initiating flow of medium around the tumor specimen, whereby the tumor specimen is preserved alive ex vivo.

[0017] In another aspect, a live tumor transport device is described, comprising a channel filled with supporting medium.

[0018] In another aspect, the live tumor transport device also comprises a means of cooling the tissue sample once it has been collected, to improve its viability during transport.

[0019] In another aspect, said live tumor transport device also comprises a core biopsy needle, and a means of delivering the core biopsy specimen from the needle into the channel, together forming a live tumor specimen collection and transport device.

[0020] In another aspect, the channel in said live tumor specimen collection and transport device is contained within a removable cassette which fits into a matching aperture in a live tumor maintenance device which comprises channels matching the apertures of the channel within the cassette, and an apparatus for initiating flow of medium in the channel.

[0021] In another aspect, a method is described comprising the steps of collecting a tumor specimen using a live tumor specimen collection and transport device, transporting the device to another location, removing the cassette containing the tumor specimen, inserting the cassette into the matching

- ή - aperture of a live tumor maintenance device, and initiating the flow of supporting medium within the channel, so that the tumor specimen may be preserved alive ex vivo.

[0022] In another aspect, the medium contains an anticancer drug.

[0023] In another aspect, the method also comprises a step whereby the tumor specimen is removed from the device, formalin fixed, paraffin-embedded, sectioned, and examined microscopically for drug effect.

[0024] In another aspect, the live tumor specimen maintenance device contains a plurality of channels, so that a plurality of tumor specimens can be maintained in the same device in the same medium.

[0025] In another aspect, the plurality of tumor specimens are maintained in a parallel, honeycomb- shaped array.

[0026] In another aspect, the plurality of tumor specimens are removed together from an-array of channels using a correspondingly shaped multi-pronged plunger, formalin- fixed and paraffin-embedded while preserving their arrangement, thus preparing a tissue microarray from ex-vivo-drug-treated tissue, to facilitate histological examination of a plurality of tissue specimens.

[0027] In another aspect, different portions of the same patient's tumor are biopsied to determine differential sensitivity of each portion to a drug.

[0028] In another aspect, the method also comprises a step whereby DNA, RNA or protein is isolated from the specimen, to determine the basis for differential sensitivity of tumor samples to a drug, and to measure the changes in RNA and protein composition brought about by drug treatment.

[0029] In another aspect, the method also comprises the step of performing a proliferation assay, apoptosis assay or a viability assay on the tumor specimen. [0030] In another aspect, the plurality of specimens are exposed to a single anticancer drug, to determine which specimens are sensitive to the drug.

[0031] In another aspect, multiple core biopsies from a single patient are obtained and exposed to a plurality of anticancer drugs, to determine which drug is most likely to have a therapeutic effect on the patient's tumor.

[0032] In another aspect, supporting medium comprises one or more of the following: growth factors, nutrients, serum, plasma, oxygen, carbon dioxide.

[0033] In another aspect, a bone marrow core is collected instead of a solid tumor core.

[0034] In another aspect, tumor is collected from a tumor-bearing animal.

[0035] In another aspect, the live tumor maintenance device comprises an apparatus to deliver a predetermined amount of oxygen to the supporting medium, and to measure the oxygen tension in said medium.

[0036] Other additional features, benefits and advantages of the present invention will become apparent from the following drawings and descriptions of the invention. Other embodiments and aspects of the invention are described in detail herein and are considered a part of the claimed invention.

Brief Description of the Drawings

[0037] The subject matter which is regarded as the invention is particularly pointed out and distinctly claimed in the claims at the end of the specification. The foregoing and other objects, features, and advantages of the invention are apparent from the following detailed description taken in

conjunction with the accompanying drawings in which:

[0038] FIG.l is a perspective view of one embodiment of a live tumor specimen maintenance device. [0039] FIG. 2 is a perspective view of one embodiment of a live tumor specimen collection and maintenance device comprising a biopsy needle and a live tumor specimen maintenance device.

[0040] FIG. 3 is a perspective view of one embodiment of a live tumor specimen collection and transport device.

[0041] Fig 4 depicts a live tumor specimen transport device of the present invention containing the removable cassette with the tumor specimen.

[0042] Fig. 5 depicts a live tumor specimen transport device with the cassette removed.

[0043] Fig 6 depicts the cassette of Fig 5 being inserted into an aperture of the live tumor specimen maintenance device.

[0044] FIG 7 is a perspective view of the plunger used to transfer tumor specimens from the cassette into a tumor specimen holder which is then paraffin embedded. A resulting microscope slide is also illustrated.

Detailed Description for Carrying out the Invention

[0045] For the purposes of promoting an understanding of the principles of the live tumor specimen collection, transport and maintenance devices of the present invention and methods for their use, reference will now be made to the embodiments, or examples, illustrated in the drawings and specific language described below.

[0046] Generally stated, disclosed herein is a device for collecting, transporting and maintaining live tumor specimens. The devices shown herein are intended for example purposes only, as many alterations would occur to one skilled in the art, and are contemplated as a part of the invention.

- Q - [0047] Referring to Figure 1 , live tumor maintenance device 5 is essentially rectangular and comprises a cylindrical tumor holding channel 1 filled with supporting medium 4. Channel 1 has aperture 32 on the top surface of device 5 and aperture 31 on the bottom surface of device 5. A tumor specimen 3 is contained within tumor holding channel 1. Lid 6 provides a leak-proof seal to close apertures 31 and 32. An alternative embodiment is contemplated in which aperture 31 is omitted, and aperture 32 is used to deposit the tumor specimen into device 5. Fluid delivery tubing 2 is connected to container 5 to allow supporting medium to flow into the tumor holding channel via a medium delivery channel 9. Supporting medium flows around the tumor as indicated by arrows 7, thus providing a source of fresh nutrients to the tumor. The medium exits the tumor-holding channel via the fluid egress channel 8, which is connected to fluid egress tubing 10. Fluid delivery tubing 2, medium delivery channel 9, medium egress channel 8, and fluid egress tubing 10 are contemplated to have internal diameters of 0.1 -0.5mm, significantly smaller than the diameter of tumor holding channel 1, so that the tumor specimen remains in tumor holding channel 1. A sieve is contemplated but not shown on the figure, contained within medium egress channel 8, may additionally serve to keep the tumor specimen within tumor holding channel 1. An apparatus for creating a flow of supporting medium within device 5 is contemplated to be part of a tumor maintenance device, not shown on figure 1. Such apparatus would be well-known to someone skilled in the art of microfluidics. An apparatus for delivering oxygen, carbon dioxide or other gases to supporting medium is also contemplated to be part of device 5, and an apparatus for measuring the resulting tension of such gases in the supporting medium, as is clear to someone skilled in the art of microfluidics. While device 5 is shown to be generally rectangular, it may also have a generally circular, oval, square, hexagonal, or polygonal shape. The following additional embodiments of device 5 are described below as they apply to device 5 shown on Figure 1. However, these embodiments are also applicable to devices shown on figures 2-6.. [0048] Device 5 may be maintained at a predetermined temperature, such as 37°C, by placing it into a fixed-temperature incubator. Channel 1 and inner surface of lid 6 may be coated with a non-adherent material such as a hydrogel to prevent the tumor specimen from sticking to the walls of channel 1 or lid 6. Supporting medium may contain any of the following ingredients: tissue culture base medium such as DMEM, RPMI, MEM; growth factors; serum or plasma of human or animal origin; nutrients such as glucose, glutamine; buffers to maintain pH. In a preferred embodiment, it is contemplated that the diameter of channel 1 will be approximately 1.5 mm to slightly exceed the diameter of a typical core biopsy specimen which is 1mm, thus allowing unimpeded flow of supporting medium around the specimen. However the dimensions of device 5, including the inner diameter of channel 1, may vary. Device 5 is shown on Figure 1 with fluid delivery channel 9 and fluid egress channel 8 at 90 degree angles to the tumor holding channel 1. However alternative embodiments are contemplated in which the angle between channel 1 and channels 8 and 9 may vary between about 30 and 120 degrees. It is further contemplated that tumor specimens of shapes other than cylindrical may be collected and maintained, such as rectangular, round, or irregularly shaped. A cylindrical core biopsy specimen may also be cut lengthwise in half to allow better access of nutrients and oxygen to the inner cells within the specimen. Therefore the geometry of channel 1 may be adapted to the geometry of the tumor specimen, such as for example a channel which is square, semicircular or oval in cross-section.

[0049] Figure 2 demonstrates a perspective view of a live tumor collection and maintenance device 34 comprising a live tumor maintenance device 5 and a hollow needle 11. A core biopsy needle with an internal diameter of approximately 1 mm is familiar to someone skilled in the art of oncology. The internal diameter of the needle may vary from 0.5mm to 3mm. The length of the needle may vary from 10mm to 100mm. Additional modifications of the needle, such as the shape of the cutting edge, a plunger to push the specimen into the needle, and a means of attaching the needle to device 5, are not shown but will be familiar to anyone skilled in the art of oncology. A cylindrical needle is shown.

However, additional shapes of the needle, such as square in cross-section, are contemplated. A method of collecting and maintaining tumor specimens alive is contemplated, whereby device 34 is used to obtain a biopsy from a patient's tumor. The tumor specimen is pushed from the needle into channel 1 of device 5 using a plunger which fits snugly into the needle. The needle is removed, and lids 6 are attached to seal channel 1. Flow of medium is now initiated to maintain the tumor specimen alive.

[0050] Figures 3-6 demonstrate another embodiment of the invention, in which a live tumor collection and transport device is separate from a live tumor maintenance device. Figure 3 depicts a live tumor specimen collection and transport device 12, comprising a removable cassette 13, which includes a tumor holding channel (dimensions) 14 filled with support medium 15 and containing tumor specimen 16. Cassette 13 further comprises medium delivery channel 17 and medium egress channel 18, with dimension and functions similar to medium channels 8 and 9 depicted in Figure 2. Device 12 further comprises a tumor specimen delivery channel 19 which is continuous with the inner bore of hollow needle 11. Channel 19 has an aperture 35 on the upper surface of device 20, best visualized in View B. Cassette 13 fits snugly into device 12 such that medium delivery channel 17 and medium egress channels 18 are sealed. Figure 4 illustrates a live tumor specimen transport device 20, formed by removing the needle from device 12, and covering aperture 35 of channel 19 with cover 6. Figure 5 illustrates device 20 with cassette 13 removed as indicated by arrow 21. Figure 6 demonstrates a live tumor specimen maintenance device 22, comprising aperture 23 into which cassette 13 fits snugly as indicated by arrow 35. Device 22 further comprises medium delivery tubing 2, medium delivery channel 9, medium egress channel 8 and medium egress tubing 10. When cassette 13 is inserted into device 22, medium delivery channel 9 of device 22 becomes continuous with medium delivery channel 17 of cassette 13, and medium egress channel 8 of device 22 becomes continuous with medium egress channel

- 1 7 - 18 of cassette 13, while tumor holding channel 14 of cassette 13 becomes sealed. A method is contemplated, as illustrated in Figures 3-6, comprising the steps of collecting a tumor biopsy using device 12 (Figure 3); removing the needle from device 12 (Figure 4); transporting device 12 to a laboratory; removing cassette 13 from device 12 (Figure 5); inserting cassette 13 into device 22 (Figure 6), whereby the tumor specimen is maintained in supporting medium from the moment it is collected, and the viability of the tumor specimen is enhanced.

[0051] Figure 7 illustrates another embodiment of cassette 13 comprising a plurality of tumor holding channels 14 in a honeycomb arrangement, each channel 14 containing a tumor specimen 16 and having essentially the same dimensions as channel 1 depicted on Figure 1. Each channel 14 leads to an aperture 32 on the upper surface of cassette 13 and aperture 31 on the lower surface of cassette 13. In this embodiment, the live tumor collection and transport device may also have a plurality of needles of approximately the same dimensions as needle 11 depicted in Figure 2, each needle communicating with corresponding channel 14. This would allow multiple cores to be collected simultaneously ex vivo from a resected surgical tumor specimen. In another contemplated embodiment, one tumor specimen is collected at a time using a single-needle collection device, and then tumor specimens are assembled together into a multi-channel maintenance device. A multichannel tumor maintenance device may be configured in a parallel fashion so that each tumor specimen receives its own supply of medium with different anticancer drugs or other supplements; alternatively, medium delivery channels may start from a common channel before branching off, such that all tumor specimens are explosed to the same medium. The arrangement of medium delivery channels, medium egress channels and tumor holding channels may vary.Figure 7 also illustrates a multi-pronged plunger 23 comprising a plurality of plungers of the dimensions and arrangement to match the plurality of channels in cassette 13. Plungers 13 are dimensioned to fit snugly into channels 14. Perspective view are demonstrated on the left, and

- - cut-out views on the right of Figure 7. Arrow 25 indicates the insertion of plunger 23 into channel apertures 32 in cassette 13 to remove tumor specimens 16. Figure 7 also demonstrates a tumor specimen holder 27 containing cylindrical chambers 28 matching the dimensions and the arrangement of the tumor holding channels 14 in device 22. Chambers 28 have apertures 33 on the upper surface of holder 27. Tumor specimen holder 27 is made of soft material which can be paraffin-embedded and sectioned along with the tumor specimens 16. When plunger 23 is inserted into cassete 13 as indicated by arrow 25, tumor specimens 16 are pushed through apertures 31 and apertures 33 into chambers 28 in holder 27. Holder 27 and tumor specimens 16 it contains are paraffin embedded and sectioned, resulting in tissue microarray slides 29 as indicated by arrow 30.

[0052] The method for using the live tumor maintenance device includes, generally: obtaining a tumor specimen; placing the specimen into the tumor holding channel of the device; and initiating the flow of supporting medium to provide a continuous source of fresh medium to the tumor specimen, thus maintaining it alive ex vivo. It is also contemplated that the tumor specimen may be removed from the device , transferred into formalin, after which the usual paraffin-embedding and sectioning procedures will ensue such as, sectioning and deposition on microscope slides so that the tumor may be examined histologically by a pathologist. Immunohistochemical stains may be applied such as a proliferation marker, Ki67. Such procedures are clear to someone skilled in the art of pathology. Such histological examination may be done to determine whether the specimen indeed comes from the tumor and not from surrounding normal tissue, and that tumor is still alive and appears to be histologically unchanged as compared to a second specimen from the same tumor which was directly fixed in formalin and paraffin embedded immediately upon collection from the patient. Thus the changes occurring in the tumor after it has been maintained in the live tumor specimen maintenance device can be studied, and a period of time can be identified during which such changes are minimal, thus establishing this period of time as a period during which drug testing may be performed on the tumor.

[0053] In an alternative embodiment, the specimen is snap-frozen rather than formalin-fixed, and frozen section is performed. It is also contemplated that an anticancer drug may be added to supporting medium at a predetermined concentration. After a period of tumor specimen maintenance in drug- containing medium, such period lasting hours, days or weeks, the tumor specimen is formalin-fixed, paraffin-embedded and examined histologically. For comparison, a tumor specimen from the same tumor may be grown in another identical device but in the absence of drug. Any differences in the histological appearance of the tumor in the presence of drug vs in the absence of drug will be due to drug effect. Thus drug effect can be studied on live tumor specimens ex vivo before subjecting the patient to side effects of the drug. This drug effect can be compared to drug effect observed in tumors removed from the patient after the patient received a course of chemotherapy, such as neoadjuvant chemotherapy, which is familiar to someone skilled in the art of pathology.

[0054] It is further contemplated that multiple core biopsies may be obtained from the patient's tumor, either through multiple passes with a core biopsy needle, or at the time of a surgical resection of a tumor fragment from which core biopsies are then collected ex vivo. Biopsy specimens are obtained, each specimen is deposited into a separate identical live tumor maintenance device, and each specimen is treated with a different drug. Thus a panel of drugs can be tested against a patient's tumor, to determine which drug is most effective against this tumor. Rather than treating a single specimen with each drug, multiple specimens may be treated with each drug, to ensure reproducibility of the findings. It is further contemplated that tumor samples from many patients can be collected , each sample deposited into a separate identical device, and all samples treated with the same drug, to determine which tumor specimens respond to the drug, thus performing an ex vivo clinical trial. In the above

- 1 - methods, where parallel studies are required with several tumor specimens, either individual devices may be used as described above, or a single device with a plurality of channels may be used as illustrated in Figure 4. It is also contemplated that the samples may be removed and subjected to DNA, RNA or protein analysis to identify characteristics that distinguish those tumors that responded to the drug from those tumors that did not, as would be well-known to someone skilled in the art of personalized medicine. It is also contemplated that during the course of days to weeks, while the tumor is maintained alive in the tumor maintenance device, the tumor specimen may continue to increase in size as the tumor would in the patient. Such growth may be tracked through repeat measurements of tumor specimen length, either manually with a ruler, or optically with a laser scanner, whereby a laser will scan the length of the tumor holding channel to measure the length of the channel occupied by the tumor specimen. It is also contemplated that other techniques for measuring viability of the tumor, such as apoptosis assays, proliferation assays or viability assays may be performed on tumor specimens while they are contained within the live tumor maintenance device or after they have been removed from the device.

[0055] Now referring to Figure 1 , the method of using a live tumor specimen maintenance device 5 is described, comprising the steps of closing lower lid 6, inserting the tumor specimen into tumor holding channel 1, closing top lid 6, connecting medium delivery tubing 2 to a reservoir of supporting medium which is not shown, and activating a medium pump, also not shown. Thus supporting medium will begin to flow around the tumor as indicated by arrows 7, so that the tumor is maintained alive ex vivo.

[0056] Further referring to Figure 1 , the method may also comprise a step of maintaining a tumor alive ex vivo for a predetermined period of time, removing lid 6 above and below the tumor, and pushing the tumor out of channel 1 by applying gentle pressure with a stick, and transferring the tumor specimen into formalin for fixation, paraffin embedding, and preparation of slides for histological examination. Alternatively, the tumor specimen may be snap-frozen, or analyzed for DNA, RNA or protein content.

[0057] Further referring to Figure 1 , the method may alternatively comprise the step of maintaining a tumor specimen alive ex vivo for a predetermined period of time in the presence of a viability dye, so that viability of the tumor may be continuously assessed through the walls of device 5, which will be transparent.

[0058] Referring now to Figure 2, the method of using a live tumor specimen collection and maintenance device 34 is described, comprising the following steps. The device comprises a hollow needle 11 such as a core biopsy needle. The needle 11 is pushed into a patient's tumor and a tumor specimen is collected within the needle. The needle 11 is removed from the patient and the tumor specimen is pushed from the needle into the tumor holding channel 1. The needle may now be removed, and aperture 32 covered with lid 6. The device now is used as a live tumor specimen maintenance device 5, depicted in Figure 1 and described above.

[0059] Referring now to Figure 3, the method of using a live tumor specimen collection and transport device 12 is described. Device 12 comprises hollow needle 11 and a live tumor specimen transport device 12 containing cassette 13. Cassette 13 comprises tumor holding channel 14 containing supporting medium. The needle 11 is pushed into a patient's tumor and a tumor specimen is collected within the needle. The needle 11 is removed from the patient and the tumor specimen is pushed from the needle into the tumor holding channel 1. The needle 11 may now be removed, and aperture 35 covered with lid 6. A live tumor specimen transport device 20 is thus formed, containing cassette 13. The device may be shipped or transported to another location. This may be done on ice to improve viability of the tumor specimen. Once at another location, cassette 13 is removed and transferred to a specially configured live tumor specimen maintenance device 22 which contains opening 23 sized to match the size of cassette 13. Once the cassette is inserted into device 22, further steps are as for device 5 depicted in Figure 1 and described above. It is contemplated that a tumor maintenance device comprising pumps, gas delivery systems, and temperature control, is located at a central laboratory and would be too cumbersome to transport to the location of the patient to perform a biopsy. Hence the method described above and the associated devices depicted in Figure 3 allow for specimen collection and transport in one device, followed by transfer of tumor specimen into another device. However, it is contemplated that a tumor maintenance device may be built to be portable and battery-operated. Such a device may then be used for transport as well as maintenance of the specimen.

[0060] Referring to Figure 4, a method of removing multiple tumor specimens from a multi- specimen live tumor specimen mainenance device is described. Cassette 13 is depicted in Figure 4 for simplicity. However the same method would apply to a multi-channel tumor maintenance device 5 depicted in figure 1. Both cassette 13 and tumor maintenance device 5 with lids removed comprise tumor holding channels 14 with upper aperture 32 and lower aperture 31. To remove the tumor specimens from channels 14, a specimen holder 27 is placed underneath cassette 13. Holder 27 has chambers 28 of the same cross-sectional dimensions as channels 14 and the same arrangement, so that chambers 28 are aligned with channels 14. Unlike channels 14 which have upper and lower apertures, chamber 28 has only upper aperture 33. Multi-pronged plunger 23 is then applied to cassette 13 to push tumor specimens through channels 14 into chambers 28. Holder 27 is made of such material that it can be formalin fixed and sectioned along with tumor specimens. One example of such material may be paraffin itself, pre-formed using a rubber mold. Holder 27 with tumor specimens inside is submerged in formalin, fixed, embedded in paraffin and sectioned. As a result, the arrangement of individual sections of tumor specimens on the slide is the same as their previous arrangement within the live tumor specimen maintenance device.

[0061] While embodiments of the invention have been illustrated and described in detail in the disclosure, the disclosure is to be considered as illustrative and not restrictive in character. All changes and modifications that come within the spirit of the invention are to be considered within the scope of the disclosure.

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Claims

Method and apparatus for collecting, transporting and maintaining live tumor specimens ex vivo Claims What is claimed is:

1. A method of maintaining tumor tissue alive ex vivo, comprising the steps of collecting tumor tissue from a patient, depositing said tumor tissue into a device comprising a microfluidic channel filled with supporting medium, and initiating flow of medium around the tumor tissue, whereby the tumor tissue is preserved alive ex vivo

2. A method of claim 1, where the step of collecting tumor tissue further comprises a needle biopsy.

3. A method of claim 2, where the needle biopsy is performed using a device comprising said needle and said channel.

4. A method of claim 2, where the needle biopsy is performed using a device comprising said needle and said channel, and a means of flowing medium into the channel.

5. A method of claim 1, further comprising the step of sectioning said tissue for microscopic examination.

6. A method of claim 1, further comprising the step of removing said tissue from the channel and sectioning said tissue for microscopic examination

7. A method of claim 5, further comprising the addition of an anticancer agent to said medium, whereby the effect of the agent on said tissue can be examined microscopically.

8. A method of claim 7, further comprising the step of extraction of DNA from said tissue, whereby a correlation of DNA mutations and the antitumor effect can be performed

9. A method of claim 7, further comprising the step of extraction of RNA from said tissue, whereby tumor RNA composition, and change in tumor RNA composition, can be measured and correlated to the antitumor effect.

10. A method of claim 7, further comprising the step of extraction of protein from said tissue, whereby tumor protein composition, and change in tumor protein composition, can be measured and correlated to the antitumor effect.

11. A method of claim 1 , where the device comprises a multitude of channels to house a multitide of tumor samples

12. A method of claim 11, where the device further comprises a multipronged plunger

13. A method of claim 11, further comprising a step of pushing the multipronged plunger into the multitude of channels to simultaneously remove a multitude of tissue specimens for sectioning, whereby several tumor specimen sections can be placed on a single microscope slide

14. A method of preserving tumor tissue ex vivo, comprising the steps of collecting a needle biopsy specimen from the patient with a device which comprises a needle and a removable receptacle cassette for said tissue, removing said cassette from said device, inserting said cassette into a device containing a means of flowing supporting medium into said channel and around said tissue, and initiating flow of medium around the tumor tissue.

15. A method of claim 14 further comprising a means of cooling the biopsy specimen during transport until flow of supporting medium can be initiated.