ATYPICAL RESPONDERS LANDSCAPE REVIEW ∙ OCTOBER, 2017 27 response compared to selection of therapies based on expression levels of a panel of relevant genes [80]. Similarly, Nagourney Cancer Institute utilizes a testing platform and process that they refer to as “Functional Profiling” in which tumor cells are kept in 3-D clusters (“microspheroids” that mimic the body’s environment) and are exposed to various drugs and combinations [81]. A study of lung cancer specimens obtained during surgery found that therapy based on functional profiling testing doubled the treatment response rate and more than doubled overall survival in patients receiving assay-directed therapy compared to historical population-directed therapy [81]. To improve patient outcomes, combined and repeated molecular and chemosensitivity testing may be needed because genetic and host attributes can change over time. EXCEPTIONAL SURVIVORS Some patients who considerably outlived their prognosis may have done so as the result of an exceptional response to conventional, integrative, or alternative therapies. Yet some exceptional survivors may not have exhibited an unusually positive response to a specific therapy, and no obvious explanation can be identified. Patients who have fared exceptionally well have cited (among other reasons) good communication with their medical team, strong family support, and a proactive attitude as contributing factors to their unexpected longevity [82, 83]. Next steps in the study of exceptional survivors should ideally integrate data such as demographics, diagnosis, prognosis, treatment history, imaging data, laboratory data, lifestyle factors, practice of CIM and/or alternative medicine, co-morbidities, saliva testing (i.e., genetic analysis of normal tissue), chemosensitivity testing, number and location(s) of metastatic lesions, and sampling of primary and metastatic tumors. The Broad Institute’s MBC Project and the University of Wisconsin-Madison Exceptional Survivors study plan to identify and study exceptional survivors. Registry data should be analyzed to detect survival patterns and to generate a testable series of hypotheses. Constructing a centralized database of not only exceptional responders and rapid progressors, but also exceptional survivors, would help formulate and improve testable theories. Certainly, more rigorous studies of this interesting and vitally important population of long-lived terminally ill patients are warranted. Some exceptional survivors may not have exhibited an unusually positive response to a specific therapy, and no obvious explanation can be identified.