Researchers from Johns Hopkins University have reported that a gene profile was predictive of relapse in patients with surgically resected Stage I non–small cell lung cancer (NSCLC). The details of this study appeared in the March 13, 2008 issue of the New England Journal of Medicine.¹

Lung cancer remains the leading cause of cancer-related deaths worldwide. In the United States, NSCLC accounts for 75–80% of all lung cancers. Most patients with NSCLC have advanced disease but some present with Stage I or II disease. The roles of adjuvant radiotherapy and chemotherapy in completely resected NSCLC have been controversial. Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with Stage IIA, IIB, and IIIA NSCLC. Adjuvant chemotherapy is not recommended for patients with Stage IA NSCLC. The benefits of adjuvant chemotherapy in patients with Stage IB NSCLC are still uncertain, and the guidelines do not recommend routine use of adjuvant chemotherapy in this group. Studies of adjuvant radiation therapy suggest it may reduce survival among patients with Stage I or II NSCLC; adjuvant radiation therapy is not recommended for these patients.

One of the problems with adjuvant therapy for all patients with early-stage NSCLC is that many patients will be treated who do not need it. Therefore, other methods of determining the need for adjuvant therapy are being explored.

The current study evaluated the predictive value of methylation of seven genes in tumor and lymph nodes of 51 patients with Stage I NSCLC who had an early recurrence and 111 patients who did not have a recurrence.  They found that the presence of methylation of the promoter regions of p16 and CDH13 in tumor and lymph nodes were associated with a 15-26 fold increase in the probability of relapse in Stage I NSCLC patients.

Comments: If confirmed, these data could help identify patients with Stage I NSCLC who might benefit from adjuvant chemotherapy. Other gene assays have reported similar findings with different sets of genes (see related news).

Related News:

Two Genes Predict Survival Following Surgery in Early Non–Small Cell Lung Cancer (2/26/2007)

Gene Expression Profile Predicts Survival in Early Stage Lung Cancer (8/11/2006)

American Society of Clinical Oncology Provides Guidelines for Adjuvant Therapy of Non–Small Cell Lung Cancer (12/11/2007)

Untreated Stage I Non–Small Cell Lung Cancer is Fatal (8/23/2007)

Stereotactic Single-Dose Radiotherapy Effective for Stage I-II Non-Small Cell Lung Cancer (NSCLC) (6/22/2007)

Carbon Ion Beam Therapy Effective for Stage I Non-Small Cell Lung Cancer (2/23/2007)

Lobectomy May Improve Survival Compared to Wedge Resection in Stage IA Lung Cancers (2/1/2007)

Survival Benefit From Adjuvant Chemotherapy for Stage I But Not Stage II-IIIA NSCLC (10/5/2006)

Benefit of Adjuvant Chemotherapy for Operable NSCLC Confirmed (6/23/2005)

Reference:

¹ Brock MV, Hooker CM, Ota-Machida E, et al. DNA methylation markers and early recurrence in stage I lung cancer. New England Journal of Medicine. 2008;358:1118-1128.