Purpose: In vitro data suggest that down-regulation of thrombospondin 1 (TSP1) expression from TXR1 is associated with resistance to taxane-based chemotherapy. The prognostic and predictive value of tumoral expression of both genes was evaluated in patients with lung adenocarcinoma treated with first-line docetaxel and gemcitabine. Experimental Design: Tumor samples from 96 patients, with stage IIIB (with pleural effusion) or IV lung adenocarcinomas, were analyzed for TXR1 and TSP1 mRNA levels by quantitative real-time PCR, from microdissected cells derived from patients' primary tumors. Results: The mRNA levels of the two genes were inversely correlated (Spearman's test = -0.49; P < 0.0001). Patients with low TXR1 mRNA levels experienced a longer median time to tumor progression (TTP; P < 0.0001) and median overall survival (mOS; P = 0.001) when compared with patients with high TXR1 expression. Patients with high TSP1 expression presented longer TTP (P = 0.002) and mOS (P < 0.0001) when compared with patients with low TSP1 expression. Moreover, patients with high TSP1 and low TXR1 expression (n = 36) presented higher prolonged TTP (P = 0.009) and mOS (P < 0.0001) compared with patients with high TXR1 and low TSP1 expression. Multivariate analysis showed that high TXR1/low TSP1 expression was an independent prognostic factor for decreased TTP (hazard ratio, 1.7; 95% confidence interval, 1.1-3.27; P = 0.016) and mOS (hazard ratio, 2.55; 95% confidence interval, 1.57-4.15; P < 0.0001). Conclusion: These data confirm the in vitro model of TSP1 and TXR1 effect on taxane resistance in lung adenocarcinomas and merit further evaluation.Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide despite the fact that significant treatment improvements have been made over the last decade (1). Combinations of "third-generation" cytotoxic agents, such as taxanes, vinorelbine, and gemcitabine with cisplatin, have emerged as new standards, producing higher response rates and, in some cases, prolonged survival. In phase III clinical trials conducted in patients with advanced NSCLC, treatment with the combination of a platinum compound and a taxane extended the median survival time to 8 to 11 months and the 1-year survival rate to 31% to 46% (2-4). As an alternative option, non-cisplatin-containing doublets have also been tested in several randomized phase III studies (5-9). The majority of them have reported that the non-platinum-containing combinations have substantial efficacy against advanced/metastatic NSCLC with a more favorable toxicity profile than the corresponding cisplatin-based regimens. Therefore, non-platinumcontaining combinations are considered as alternative options to platinum-based regimens in the first-line setting, especially for patients who have a contraindication for platinum administration (10).The antitumor activity of taxanes (paclitaxel and docetaxel) is the result of their binding to the β subunits of tubulin, which causes the stabilization of tubulin polymerizat...