The ORACLE test has emerged as a groundbreaking tool in the fight against lung cancer, offering predictions of overall cancer survival that surpass current clinical risk factors, especially in stage 1 lung cancer. A high ORACLE score indicates a greater risk of cancer spread and could help identify patients who might benefit most from chemotherapy.
Developed in 2019 to address the absence of biological markers in lung cancer, ORACLE examines genes expressed at varying levels across different parts of a tumor. This approach overcomes the limitation of traditional methods, which capture less than 1% of a tumor's genetic information. The test's ability to predict survival rates and the likelihood of cancer spread was validated in a study involving 158 lung cancer patients, part of the Cancer Research UK-funded TRACERx study.
For stage 1 lung cancer patients, who typically undergo surgery without chemotherapy, ORACLE's predictions could be a game-changer. Approximately a quarter of these patients experience cancer recurrence, indicating a potential benefit from more aggressive monitoring or chemotherapy. The test's findings suggest that patients with high ORACLE scores may respond better to certain chemotherapy drugs, particularly platinum-based treatments like cisplatin, due to the association of high scores with unstable DNA or chromosomal instability.
The research team is now focused on comparing outcomes for patients with high ORACLE scores receiving standard care versus those undergoing more surveillance or chemotherapy. This comparison aims to determine if ORACLE can improve survival rates even for patients diagnosed at the earliest stages of lung cancer.
Experts involved in the study, including Dhruva Biswas and Yun-Hsin Liu, emphasize the potential of ORACLE to inform treatment decisions by predicting survival rates and identifying patients who could benefit from specific chemotherapy drugs. Charles Swanton highlights the urgent need for better markers to classify tumors and predict high-risk patients, given lung cancer's status as the leading cause of cancer-related deaths worldwide.
The study's progress towards clinical application is supported by the National Institute for Health and Care Research UCLH Biomedical Research Centre, with the Crick Translation team and industry partners working to maximize patient benefits from ORACLE.
