Establishing a national tissue bank for surgically harvested cancer tissue

There is a rapidly growing realization that to exploit the genomic revolution in medicine fully will require the application of evolving molecular technologies to clinical tissue specimens1. As the introduction of cell culture techniques into biochemical laboratories in the 1960s enormously expanded our capacity to dissect complex, interacting metabolic and signal transduction pathways, so too will the application of gene sequencing, proteomic and polymerase chain reaction methodologies to surgically harvested cancer and adjacent normal tissue. The concept of ‘molecular signatures’ whereby the neoplastic tissue might be ‘typed’ according to the pattern of gene and protein expression, and correlated with cancer stage, prognosis and natural history2, is an important step towards individualizing subsequent treatment selection, such as adjuvant chemotherapy, radiotherapy or treatment with somemechanistically novel anticancer agent3. There is no doubt that histological classification and immunocytochemical characterization are the bedrocks upon which therapeutic decisions and prognostic advice are currently based, but there is recognition of their shortcomings. For example, conventional wisdom suggests that the expected 5year survival rate for a patient with stage II (Dukes’ B) colorectal cancer is around 80 per cent and that this population does not gain significant benefits from adjuvant chemotherapy. Nevertheless, in a significant minority (about a fifth) the cancer will recur and lead inevitably to death. There is much current activity aimed at assessing a range of molecular markers that might allow definition of this poor prognostic subgroup and whether additional pharmacodynamic markers might select those individuals most likely to respond to particular cytotoxic drugs2. How can clinicians contribute to this compelling science? All the leading laboratories in this field need access to carefully collected cancer samples (tissue, serum, DNA) that are linked to demographic and clinical outcome data. A decision, therefore, has been taken in the UK to fund and establish a National Cancer Tissue Resource (NCTR).