Lace up.

For more genomic tests. The Lung Adjuvant Cisplatin Evaluation (LACE) report was the succinctly named meta-analysis that demonstrated a survival advantage with the addition of adjuvant chemo for resected non-small cell lung cancer (NSCLC) stage II and greater. A post-hoc analysis of archival tissue specimens from these decades-old trials was performed to assess utility of a “targeted” gene panel in predicting benefit with chemo. Because what medical device company doesn’t want to jump on that winning Oncotype train? After evaluating various potential genetic predictors including aberrant DNA repair pathways, tumor-infiltrating lymphocytes, and TP53 status, only one predictor stood out: that’s right, the totally in vogue tumor mutation burden (TMB). Here “high” TMB was defined as >8 distinct mutations per megabase pair and was significantly associated with longer lung-cancer specific survival (LCSS). What’s more, “low” TMB, defined as <5 distinct mutations per megabase pair, was a predictor of significantly enhanced benefit in LCSS with the addition of chemo. All that’s lacking now is prospective validation...and reliable insurance coverage. TBL: Predictive genetic panels are on the horizon for early stage NSCLC. | Devarakonda, J Clin Oncol 2018