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Gene test may aid in treating lung cancer

Rating

3 Star

Gene test may aid in treating lung cancer

Our Review Summary

This story reports on a study from Japan published in this week's New England Journal of Medicine. The authors report on the use of genetic profiling to distinguish different types of lung cancers. Because there are so many different types, it can be difficult to predict how well an individual may respond to therapy. This type of gene profiling may eventually be able to discriminate which patients are the most likely to benefit from chemotherapy from those who could possibly be spared the toxic regimens. However, until this kind of gene profiling is combined with actual treatment decisions, we won't know if the testing will live up to its promise.

 The story does provide survival times for those categorized as "high" or "low" risk. What we really would want to know is how this relates to the use of chemotherapy – if those at high risk could be the ones to most benefit from chemo or if those at low risk could be spared the toxic therapy. But the story points out that this information is not yet available.

However, the story does not comment on harms of the testing. False postive or negative tests could have serious consequences if treatment decisions are made on the basis of the genetic tests. For example, it is possible that a person could be mistakenly labeled "high" risk when they really aren't and undergo grueling chemotherapy that they may not benefit from. Furthermore, although the story does mention conventional staging methods and states that this method is deficient, the story does not adequately describe the advantages and disadvantages of the new method by comparison or explain how the gene testing would fit with existing methods. For example, currently, survival is not predicted just based on stage of disease, but must also factor patient age and comorbidities, and other risk factors (including end-of-life decisions).

Finally, the story states that "widespread use is perhaps a few years away." While this may be true, there is no justification provided for this estimate. That may be an overly optimistic prediction.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention costs of genetic testing. While cost estimates may not yet be available, the story could have speculated on potential costs or mentioned the range of costs for genetic testing in breast cancer.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story does provide survival times for those categorized as "high" or "low" risk. What we really would want to know is how this relates to the use of chemotherapy – if those at high risk could be the ones to most benefit from chemo or if those at low risk could be spared the toxic therapy. But the story points out that this information is not yet available.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story does not comment on harms of the testing. False postive or negative tests could have serious consequences if treatment decisions are made on the basis of the genetic tests. For example, it is possible that a person could be mistakenly labeled "high" risk when they really aren't and undergo grueling chemotherapy that they may not benefit from.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story adequately describes the strength of the available evidence.

Does the story commit disease-mongering?

Satisfactory

The story does not exaggerate the seriousness or prevalence of lung cancer.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes several experts and points out who is an author on the study.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Although the story does mention conventional staging methods and states that this method is deficient, the story does not adequately describe the advantages and disadvantages of the new method by comparison or explain how the gene testing would fit with existing methods. For example, currently, survival is not predicted just based on stage of disease, but must also factor patient age and comorbidities, and other risk factors (including end-of-life decisions).

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story states that "widespread use is perhaps a few years away." While this may be true, there is no justification provided for this estimate, which may be overly optimistic. 

Does the story establish the true novelty of the approach?

Satisfactory

The story clearly states that genetic profiling for cancer is not new (it is currently used for breast cancer), but that this is an emerging idea for lung cancer.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Because the story quoted multiple experts and quotes from the editorial in the New England Journal of Medicine, the reader can assume the story did not rely on a press release as the sole source of information.

Total Score: 6 of 10 Satisfactory

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