Do predictive signatures really predict response to cancer chemotherapy?

Predictive signatures are gene expression profiles that should predict the response of tumors to chemotherapy in patients. Such signatures have been derived from the response of tumor cell lines to chemotherapy, but their usefulness in patients remains controversial, as the most spectacular published signatures are based on unreliable data. We discuss why it is difficult to derive meaningful predictive signatures from cell line panels and we argue that it is implausible that fully predictive signatures can be obtained for classical chemotherapy from oligo-based gene expression arrays. One reason is that resistance to chemotherapy can be caused by alterations in (the expression of) a single gene. We do not expect that such subtle alterations will be reliably picked up by standard gene expression profiling. We delineate alternative approaches that should be able to yield predictive markers that can be used for optimizing patient treatment.