Manuscript review #1, received along with rejection letter from Dr. Barnett Kramer, Feb. 11, 2003

The article by L. Weisenthal et al presents data demonstrating the clinical relevance of an in-vitro chemo-sensitivity assay as concerns:

(a) significant differences in chemo-sensitivity in specimens from previously treated ovarian cancer patients as compared to those from untreated patients and (b) in-vitro chemoresistance correlating with decreased survival in ovarian cancer patients.

Critique. This is a very lengthy article which should be significantly shortened. The authors should try to remain objective when writing an article. It is to their credit that they have continued to develop an in-vitro chemo-sensitivity assay. However, there are several problems with this article:

1. The authors do not know the extent of the patients' disease, performance status, etc. in their patient sample. Without this information, correlations with survival are not meaningful.

2. The sample size is small and it is not indicated how many patients are in each group.

3. The authors do not know the actual type of treatment. Without this information, correlations with survival are not meaningful.

4. Table 2 is just 2 cases and should be omitted.

5. The discussion involving the appropriate treatment of ovarian cancer should also indicate positive effects such as improvement in median survival with platinum based therapy.

6. The ultimate utility of any chemo-sensitivity assay will require carefully planned prospective trials with co-operative groups capable of defining stage, performance status, etc.

7. I am a clinical investigator who favors the idea of using chemo-sensitivity assays to identify new treatments. However, I do not find enough evidence to support this approach in this article.