Can gene tests show how much treatment lung cancer needs?

Researchers at cancer centres have confirmed that gene tests can predict which lung cancer patients have a lower chance of survival, and so which patients may need more intensive treatment.

They examined tumour samples from 442 lung cancer patients at six cancer hospitals in North America, studying the activity of hundreds of genes along with other predictors such as tumour stage and the patient's sex and age. The results showed that patients could be divided into groups with good and poor survival.

Typically, lung cancer patients receive chemotherapy after surgery to lower the risk of the cancer coming back. But some patients in the first stage of the disease have aggressive cancer with a poor outlook, while some classed as stage two or higher have less aggressive disease with a good outlook. The question is how to identify who needs extra treatment and who doesn't.

"We found that combining clinical information with gene activity gives a more reliable measure," says Dr David Beer. "Gene activity isn't just a black box: understanding it well lets us use the information more effectively."

Lung cancer is complex, with several types and subtypes, most of them directly linked with smoking, which causes many genetic changes. Before a simple gene test can be offered, scientists will need a precise model of the differences between patients' tumours. Gene activity is a promising predictor of how lung cancer will progress, but there may be difficulties in using it in clinics, and studies continue.