The recent success of targeted therapies for advanced cancer patients has depended on cheaper and more accessible genomic sequencing technology to identify patients who may benefit most. Yet a new study concludes that genomics can play a critical role much earlier in the staging of patients with non-small cell lung cancer (NSCLC) and could influence survival.

Researchers from the University of California, San Francisco, and Brigham and Women’s Hospital at Harvard Medical School in Boston, Massachusetts, looked at 238 patients with NSCLC who had undergone surgery and found that identifying their molecular makeup helped determine which individuals would be considered high risk.

“Looking at the genomic aspect of tumors allows us to get deeper than just looking at the microscopic appearance of the tumor and see how aggressive they are biologically,” said Johannes Kratz, MD, FACS, director of minimally invasive and robotic thoracic surgery at the University of California San Francisco (UCSF) and coauthor of the study that was published in December 2019 in JAMA Network Open. “We can make a more accurate prediction of which patients will recur and better predict survival.”

Dr Kratz said that incorporating molecular analyses to determine patients’ prognoses helps address a problem unique among this cancer population: why one-third experience recurrence after surgery to remove their tumors. “When you compare our recurrence rates with other solid tumors, there’s something biologically different with lung cancer. We have the worst outcomes for surgically-resected diseases because these tumors are deadly,” he said.

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The authors argued that the addition of genetic information helped oncologists more accurately estimate patients’ chances of disease-free survival 3 years from the time of surgery. That knowledge can guide physicians in determining who should receive additional chemotherapy. “It often helps high-risk patients, but if you treat people who are low risk, it can harm them,” said Dr Kratz.

The findings are important because they make the case to overhaul the latest conventional TNM staging guidelines that were released in 2018 by adding a molecular classifier to the other 3 criteria of size of tumor, spread of cancer to lymph nodes, and whether the cancer has metastasized. “The way we’ve been looking at aggressive tumors with these guidelines haven’t helped,” Dr Kratz said. “Until recently we haven’t had a way to distinguish high-risk and low-risk patients.”