All the rigorous clinical trials that have been identified are the "best" treatments for the "average" patient. This has been referred to as the lowest common denominator theory of cancer treatment. But cancer is not an "average" disease. Cancer is far more heterogeneous in response to various individual drugs than are bacterial infections.
The heterogeneity of human cancer is shown both by the fact that some patients derive great benefit from treatments which fail to help (and often harm) the majority of patients who receive the treatment. And many patients fail to benefit from 1st line chemotherapy, only to derive great benefit from 2nd or even 3rd line chemotherapy. These patients should have received the correct treatment the first time around. Everyone would agree that the earlier in the course of the disease that the most active treatment is given, the better the result for the patient.
Cell culture assay tests provide powerful prognostic information. They can tell you that a given form of treatment has an above average probability of being associated with a clinical response and/or with being associated with above average survival. Likewise, they indicate that a given treatment is associated with a below average probability of response and/or survival. For many cancers, especially after a relapse, more than one standard treatment exists. The system is overloaded with drugs and underloaded with wisdom and expertise for using them.
In order to do this testing, sample or biopsy (200mg in size) of the tumor is necessary. In having a biopsy, request that enough tissue be gathered for this as well as for other tests intended for the sample. I only hope that you would have the understanding of a couragious physician that would look into these things for you and provide the needed connections. The specialized laboratories will provide your physician with in depth information and research on the testing they provide.
The previous standard always used to evaluate any type of medical test has always been the correlative and predictive "accuracy" of the test. How well does a Bacterial Culture and Sensitivity Test predict for clinical success or failure of penicillin therapy? Not only is test accuracy (not "efficacy") the established standard for evaluating every single test used in medicine, it is also the precise standard used by the FDA in approving a test kit for Cell Culture Drug Resistance Testing. The FDA didn't require proof of "efficacy" (as it has never required proof of "efficacy" for any medical tests).
It is true that what happens in the lab is not necessarily what happens in the patient. Individual testing of patients are not scale models of chemotherapy in the patient, anymore than the barometric pressure is a scale model of the weather. But it's always more likely to rain when the barometer is falling than when it is rising, and chemotherapy is more likely to work in the patient when it kills the patient's cancer cells in the laboratory. It's no different than any other medical test in this regard.
Why is it so necessary to protect the patient from information provided by a perfectly rational laboratory test, supported by a wealth of entirely consistent data? If used to assist in the selection of a regimen chosen from a series of otherwise reasonable alternatives, then patients will never be harmed and best available evidence strongly indicates that they will often be helped.
I think that a savvy patient should ask his doctor to show the patient the survival curves for a given recommended form of empirical treatment, including the survival of patients treated on phase II and phase I trials which the doctor may recommend. The patient could also ask the laboratory for the survival curves of patients for whom laboratory tests have been ordered. In the absence of survival data directly pertaining to the recommended treatment or test, the patient could then listen to explanations of why such data are not available. And then decide as to the best course of action.
It is likely that surgical skill is a more important determinant of prognosis than the aggressive nature of the cancer or its stage at diagnosis. In cancer treatment, surgery is generally used only if it can cure the cancer. It is most useful in cancers that have not spread. However, if the cancer has spread to only one area or is small, then it may be possible to remove it completely with surgery. Some surgeons view chemotherapy as a remedy for "bad" surgery. Chemotherapy just isn't good enough to make up for surgical mistakes (e.g. failure to get good margins, tumor spills during surgery, etc.). The most important prognostic factor is the surgeon!