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J Thorac Cardiovasc Surg 2007;133:361-363
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr David M. Jablons (San Francisco, Calif). It is a pleasure to review this paper. I have only a few questions and some observations.

What we have heard here this morning, or at least what is in the manuscript, is a retrospective analysis of a large, prospectively gathered sample of patients with early-stage resected NSCLC for the purpose of assaying in a primary cell culture system—remember, on agar—chemotherapy resistance, not sensitivity. It is an impressive experience over many years. More than 4500 fresh tumor samples were submitted to a commercial entity, Oncotech, Inc, which is a for-profit organization, for chemoresistance testing and ultimately recently gene analysis. This a reimbursable test currently that has gained some but not universal acceptance. An important distinction was brought up in the talk and needs to be reinforced: these assays are chemoresistance and not chemosensitivity, and as such the authors argue are more "credible" and more predictive of clinical response. It may be that they are right, but certainly no assessment can be made from the dataset presented today. I would agree to a certain extent that a tritium proliferation assay in a long-term culture of 5 days on agar is perhaps more quantifiable and may be more accurate. Perhaps the advantage of having a crude tumor preparation where you have a lack of tumor cell isolation and you have no macrodissection or microdissection can either be a good or a bad approach, in my opinion. It is good in the sense that it is more representative of the actual tumor perhaps in its milieu with stromal cells and vascular cells and immune cells and maybe the purported cancer stem cells. Yet it may be that the lack of tumor . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2007 133: 352-363. [Abstract] [Full Text] [PDF]