Using Tumor Genetics To Better Understand Lung Cancer Recurrence

For patients with stage 3 non-small cell lung cancer (NSCLC) that cannot be treated with surgery, a combination of chemotherapy, radiation therapy and immunotherapy has been the standard of care. 

Jongmyung Kim, MD, PhD

The Pacific Trial established this approach in 2017, showing that adding immunotherapy after chemotherapy and radiation improves survival rates and reduces the risk of cancer progression. 

“Even with that regimen, five-year overall survival is around 40%,” said Jongmyung Kim, MD, PhD, a radiation oncologist at Moffitt Cancer Center.

Kim and his team are working to better understand why. A new study presented at the American Society for Radiation Oncology annual meeting examines patients’ tumor genetics and clinical factors to identify characteristics associated with cancer recurrence after treatment. 

A Closer Look 

The team analyzed 114 patients with stage 2 and 3 NSCLC treated with chemotherapy and radiation followed by immunotherapy between 2017 and 2025.  

They evaluated 252 cancer-related genes in patients’ tumors and compared that information with details about each patient’s cancer and treatment. The goal was to determine whether certain characteristics were more common among patients whose cancer returned.  

The Findings 

The study confirmed that cancer recurrence remains a challenge for many patients.  

Kolade Olabode, MD

“Our study showed what we know already. A lot of the patients, upward of 30%, are still recurring,” explained Kolade Olabode, MD, a resident physician in the Radiation Oncology Department at Moffitt and co-author of this study. 

Researchers also identified 68 gene mutations among patients whose cancer returned locally or spread to other parts of the body, along with specific pathways that eventually led to recurrence.  

“We’ve identified the genes, we’ve identified the pathways, and hopefully, looking ahead, we will be able to design some remedies to avoid this mutation, or tackle the mutation down the road,” Olabode said. 

Looking Ahead 

Researchers say the findings could eventually help identify patients at higher risk of cancer recurrence and guide more personalized treatment and follow-up care. 

“The goal is to be able to develop targeted therapy and precision therapy that would address the genes and pathways we have identified,” Olabode said. “Hopefully, we can circumvent these problems and be able to give a lot of relief to our patients and prevent a lot of recurrence down the road.” 

The research could also help doctors determine how closely to monitor patients after treatment. 

A brain MRI is not currently part of standard follow-up care after chemotherapy and radiation, but it could be useful to patients who are more likely to have their cancer return. 

“Follow-up surveillance is what’s critical,” Kim said. “If we identify patients who are at high risk of recurrence, or recurrence in the brain, from the beginning, we can add brain MRI to their follow-up care.”