Bladder cancer gene test predicts lymph node involvement

A new molecular test appears to predict lymph node involvement in bladder cancer patients and may help physicians determine which patients are candidates for neoadjuvant chemotherapy, say researchers from the University of Colorado Cancer Center, Aurora.

The test analyzes 20 genes on tumor biopsies. Using the test, pathologists can determine the levels for the 20 genes in the diagnostic tissue sample and indicate whether the patient has cancer in the lymph nodes. In their study, the University of Colorado researchers used it to analyze tumor samples from the United States, Canada, and Germany.

"Randomized clinical trials have shown that giving neoadjuvant chemotherapy extends patient lives, but only 5% to 15% of patients benefit," said senior author Dan Theodorescu, MD, PhD, of the University of Colorado Cancer Center. "Patients who have cancer in the lymph nodes at time of diagnosis are likely to benefit the most.

"We validated the test’s ability to predict lymph node spread of the cancer in a large sample of patients from a randomized trial," Dr. Theodorescu added. "The predictive ability held up. If this new test is used to guide neoadjuvant chemotherapy, we hope it will both help people with positive nodes live longer and keep people with negative nodes from being overtreated."

A clinical trial of using the test as a treatment guide is being planned.

Results from the study were published in Lancet Oncology (2011; 12:137-43).