Cancer staging is an important clinical tool. At the very least, agreement on a staging system allows us to compare treatment regimens and choose the best one for our patients. But classical staging—based on anatomical and pathological criteria as in the TNM system–doesn’t always predict response to treatment.

Modern genotyping techniques offer an alternative to classical staging. In the latest issue of The New England Journal of Medicine (356(1), January 4, 2007), a group of researchers from Taiwan report on a using gene signatures for determining clinical outcome in non-small cell lung cancer (NSCLC) (Chen, HY et al.: A five-gene signature and clinical outcome in non-small cell lung cancer).

The Taiwan group used microarrays to look at some 672 genes that were associated with invasive activity. They fine-tuned their analysis to identify 16 genes that were associated with survival and further reduced the set to five genes that were “independent predictor[s] of relapse-free and overall survival.” The researchers note that using PCR techniques with a small set of genes can be a practical clinical test.

For example, the authors note that “cisplatin-based adjuvant chemotherapy is effective in some patients with NSCLC. We propose that patients who have tumors with a high-risk gene signature could benefit from this type of adjuvant therapy, whereas those with a low-risk gene signature may be spared what would be unnecessary treatment.” The side-effects of cis-platin, as many of you know, can be quite unpleasant.

I’ll admit the actual article—especially the methods section—was rough sledding. Much of the vocabulary of modern genetic medicine is foreign to us who were in med school 25 or more years ago. But the fact remains that genetic medicine is becoming an ever greater part of modern medical practice, and it behooves us all to become familiar with its principles.

I’ve posted on this general topic elsewhere in the blog, including here and here.

Technorati Tags: cancer staging, non-small cell lung cancer, microarrays, gene signatures

This entry was posted on Saturday, January 6th, 2007 at 11:48 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.