Lung cancer remains one of the most common and deadliest cancers; however, it is currently difficult for physicians to provide patients with an accurate prognosis.
Current guidelines for non-small cell lung cancer (NSCLC), which accounts for 85 percent of lung cancer deaths worldwide, recommend clinicians take a small tumor sample to determine a patient’s prognosis. Unfortunately, tumor sampling is not highly accurate, as different areas of a tumor can have different genetics.
“Tumor stage is the standard measure for assessing a lung cancer patient’s risk of progression and death, and is important to guide chemotherapy decisions,” said Dhruva Biswas, MBBS, PhD, associate research scientist (cardiovascular medicine) and a member of the Cardiovascular Data Science (CarDS) Lab. “Yet even among supposedly low-risk, Stage I patients, up to 30 percent die within five years. A validated molecular biomarker could improve these outcomes."
Biswas and researchers at the Francis Crick Institute and the University College London (UCL) Cancer Institute developed a test called ORACLE. This test analyzes genes from every part of the tumor to give a more accurate prognosis for people with lung adenocarcinoma, a common type of NSCLC lung cancer.
In a new study published in Nature Cancer, the researchers found that ORACLE can better predict patient survival than the current clinical standard, even at the earliest stage of cancer. The findings are based on prospective data from 158 patient records.
The study found that ORACLE more accurately predicted which patient’s cancer was likely to spread and how well a patient’s tumor would respond to certain chemotherapy drugs. The study builds on previous research showing ORACLE’s effectiveness with a larger dataset of retrospective patient data.
“We’re very encouraged by these study results,” said Biswas, who is co-first author of the paper. “While more validation is needed, we hope that doctors could one day use ORACLE to help develop a more accurate surveillance schedule, select targeted cancer therapies, and ultimately help patients live longer,”
To further validate the test, the researchers plan to conduct a randomized controlled trial to determine if the test improves patient survival.
Biswas, D., Liu, YH., Herrero, J. et al. Prospective validation of ORACLE, a clonal expression biomarker associated with survival of patients with lung adenocarcinoma. Nat Cancer (2025). https://doi.org/10.1038/s43018-024-00883-1
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