Lung cancer researchers have identified a genetic signature that can helpdoctors determine which patients with early-stage non-small cell lung cancerare at high risk for developing disease recurrence and therefore may benefitfrom chemotherapy after surgery ("adjuvant chemotherapy").
"The findings give patients and their doctors a clearer map of theappropriate post-operative treatment route to follow. Not all patientsbenefit from chemotherapy after surgery and those with less aggressivecancer may be spared from the potentially debilitating side effects of thistreatment," says principal investigator Dr. Ming Tsao, pathologist at thePrincess Margaret Hospital (PMH) Cancer Program, University Health Network(UHN), and Professor of Laboratory Medicine and Pathobiology at theUniversity of Toronto. He also holds the M. Qasim Choksi Chair in LungCancer Translational Research at UHN.
"Our study was rigorously validated by multiple testing across data fromdifferent patient populations and so we believe these findings can beapplied generally to other patients with early-stage non-small cell lungcancer," says Dr. Tsao.
"The ability to tell whether a particular patient is a good candidate foradjuvant chemotherapy will bring us closer to our goals of improving patientcare through personalized medicine," adds study collaborator Dr. FrancesShepherd, PMH medical oncologist and holder of the Scott Taylor Chair inLung Cancer Research at UHN.
The study, published online today in the Journal of Clinical Oncology (JCO64325), advances the 2005 findings of the NCIC Clinical Trials Group studyJBR.10, conducted in collaboration with the U.S. National Cancer Institute.The JBR.10 findings showed significant survival benefit from the anti-cancerdrugs vinorelbine and cisplatin in patients with early-stage (stage I andII) non-small cell lung cancer whose tumors had been surgically removed. Dr.Tsao's research team and collaborators at NCIC Clinical Trials Group atQueen's University performed a genetic analysis of tumor tissue from 133 ofthe 482 patients from the JBR.10 study who had banked frozen tumor samples.
The Tsao team identified a set of 15 genes that, in 62 patients who did notreceive chemotherapy after surgery, predicted which patients had aggressivecancers with high risk of recurrence and death (31 patients), and which hadless aggressive disease and low risk of recurrence (31 patients).
They then applied the signature to 71 patients who were randomized toreceive chemotherapy in the JBR.10 trial. Patients predicted to haveaggressive diseaseexperienced the greatest benefit from chemotherapy - with a 67 percentreduction in the risk of death - while chemotherapy did not reduce the riskof death in patients designated as low risk.
While a previous JBR.10 analysis showed that overall only patients withstage II disease benefited from chemotherapy after surgery, Dr. Tsao's studydemonstrates that the 15 gene signature may identify patients with bothstage I and II cancers who may benefit from post-operative chemotherapy.
Source: University Health Network