A pharmacogenetic testing approach developed by researchers at Duke University Medical Centre in the USA could identify patients with early-stage lung cancer that would benefit not just from surgery but also chemotherapy.

The test is designed to improve on the current staging system for non-small cell lung cancer, which is used to determine how patients presenting with the disease are treated. At present, those with small, localised tumours - known as Stage IA disease - tend to be treated with surgery only, while those with more advanced disease that has spread outside the lungs will be offered chemotherapy as well.

But the Duke genetic profiling approach can identify even the tumours that are most likely to recur, so aggressive treatment can be started regardless of tumour staging. Around a quarter of patients with early-stage NSCLC see their cancer recur despite surgery.

"Clinical trials have indicated a benefit of adjuvant chemotherapy for patients with stage IB, II, or IIIA - but not stage IA," according to the authors.

The technique involves taking samples from tumour bipsies and undertaking a genetic profiling analysis to look for gene sequences known to increase the risk of recurrence.

The study, reported in the New England Journal of Medicine (August 10), suggests that the approach is more than 72% accurate in predicting which patients would relapse, and so benefit from adjuvant chemotherapy.