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August 4, 2017. Time to concentrate on the curable cases. Remember, adjuvant therapy is not currently recommended for stage I NSCLC following complete resection. But what about those early-presenting tumors that still have bad biology? As we’ve recently discussed in the context of GBM, genomic tests are the way of the future. Oncotype DX has already transformed the paradigm of treating early-stage breast cancers and now has a market share in two of the other Big Four: colon and prostate cancers. This month’s JAMA Onc pub is looking to complete the quartet. A novel genomic assay was put to the test on nearly 2500 completely resected Stage I-II nonsquamous NSCLCs. The assay is based primarily on immune-related gene pairs, which makes sense given the response rates seen with immunotherapies. But it more than makes sense: it was independently predictive of overall survival and even more accurate when used in conjunction with other known clinicopathologic factors. You’re going to see more of these early-stage lung cancers as routine screening guidelines are put into practice, so don’t let the small but scary ones slide.