Today we cannot predict the behavior of individal patient tumors and need to overtreat some patients and undertreat others. However, the science behind lung cancer has now moved a step forward by identifying a “molecular signature” of key genes that may predict patient survival. This week’s New England Journal of Medicine (NEJM) included a very provocative manuscript by a group in Taiwan that studied tumor tissue from a series of patients who had surgery for NSCLC and identified five key genes that could help them separate those with a good prognosis from those with a poor prognosis. Similar to a prior NEJM article from a research group at Duke that identified a large collection of genes that distinguished better prognosis and worse prognosis patients with early stage NSCLC, the article this week by Chen and colleagues out of Taiwan was designed to do a better job than just relying on our current staging system to predict clinical outcomes for patients with lung cancer.

Their technique was complex, and these results need to be reproduced widely before this approach becomes established and incorporated into clinical decision-making. But there were certainly robust differences between the two groups they identified by molecular signatures. The median survival was twice as long in the low-risk group as in the high risk group (40 months vs. 20 months), and there was a more than doubling in the median relapse-free survival (29 vs. 13 months for high- vs. low-risk, respectively).

I’ll review some of how they came to this point, but even trying to simplify this, it’s pretty scientifically complex. You may want to take some Tylenol in advance. Read the rest of this entry »