Test predicts chemotherapy benefit for lung cancer

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http://www.sciam.com/article.cfm?chanID ... C8BE6CA23A

By Gene Emery

BOSTON (Reuters) - The presence or absence of a protein in lung cancer cells can help doctors predict whether chemotherapy will help patients live longer after surgery, European researchers reported on Wednesday.

The study published in this week's New England Journal of Medicine could help doctors determine which patients can benefit from a type of chemotherapy before treatment starts.

"The results suggest that we may have a tool that can distinguish between patients who can benefit from platinum-based chemotherapy and those who cannot," said Eddie Reed of the Centers for Disease Control and Prevention in Atlanta, in an editorial that accompanies the study.

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"In theory, our discovery is applicable to other tumor types, although this is not proven in our analysis," coauthor Jean-Charles Soria of the Institut Gusatve Roussy, in Villejuif, France, told Reuters.

Volunteers with undetectable levels of the protein ERCC1, which is important in repairing DNA, had a five-year survival rate of 47 percent when treated with the platinum-based class of chemotherapy drugs such as cisplatin.

The survival rate dropped to 39 percent without treatment after surgery to remove the tumor.

When the tumors had plenty of ERCC1, the situation was reversed. Those who received no chemotherapy did better than those who did. The survival rate was 46 percent for untreated patients, compared with 40 percent for those who got cisplatin.

"A low level of expression of ERCC1 by tumor cells was associated with longer survival" after cisplatin-based chemotherapy, said the team, led by Ken Olaussen of the University of Paris.

Lung tumors are, by far, the commonest form of cancer. striking over 174,000 people in the United States each year and killing 162,000. Most are caused by smoking.

The new study, involving 28 medical centers in 14 countries, looked at non-small-cell lung cancer, which makes up about 87 percent of all lung cancer cases.

The researchers wanted to see if there was a better way to predict who would benefit from chemotherapy. They focused on ERCC1 because it is involved in repairing the tumor DNA that cisplatin seeks to destroy.

In the 426 people with undetectable levels of the ERCC1 protein, average survival was 56 months if they received chemotherapy and 42 months if they did not.

When ERCC1 was present in the tumors, the 170 patients who received no additional treatment after their surgery typically survived 55 months, compared with 50 months for the 165 who got cisplatin.

Soria said the test should be widely available in medical centers.