Thanks to the rollout of low-dose chest CT screening programmes, lung cancer is now being detected at earlier stages, often before symptoms appear. These diagnoses mainly concern lung adenocarcinoma, the most common type of lung cancer. At these very early stages, known as stage 0 or IA, surgery remains the standard treatment and generally leads to good outcomes.
However, patient follow-up shows that this approach is not always sufficient to prevent disease progression. Despite early surgical intervention, some patients develop recurrences or metastases in the years that follow. Conventional analysis of tumour tissue, based on microscopic examination, does not consistently identify tumours with more aggressive behaviour. This highlights the need for complementary tools to better assess risk from the time of diagnosis.
Gaining deeper insight into tumours through genetic analysis
To address this challenge, teams at IHU RespirERA conducted a study involving 239 patients with very early-stage lung adenocarcinoma. This research is based on next-generation sequencing, a technology that makes it possible to analyse multiple genes simultaneously that are involved in cancer development.
The approach used, known as “reflex” sequencing, involves systematically performing this genetic analysis at the time of initial diagnosis. The aim is to better characterise the tumour as soon as it is detected, without waiting for potential disease progression. This strategy seeks to establish a molecular profile of each cancer by identifying biomarkers that could guide patient monitoring and clinical management.
Fast and information-rich results
The study results show that this approach is not only feasible but also particularly rapid. Complete genetic profiles were obtained in just over four days on average, a turnaround time compatible with the constraints of routine clinical care.
From a scientific perspective, the analysis reveals that the majority of tumours already harbour genetic alterations, even at a very early stage. Some of these alterations affect well-known genes involved in cancer cell growth, for which targeted therapies already exist or are currently under development. Overall, around one third of patients present genetic alterations considered clinically relevant, opening the door to more personalised management.
Towards a more precise classification of lung cancers
The study also highlights links between the genetic alterations identified and the microscopic appearance of tumours. Certain mutations are more frequently associated with cancers that display less aggressive behaviour, while others are more commonly found in more invasive tumours. These findings confirm the value of combining traditional histological analysis with data obtained through genetic sequencing.
By integrating this information at the time of diagnosis, it becomes possible to refine the classification of lung cancers and to better stratify patients according to their actual risk of disease progression.
IHU RespirERA at the forefront of innovation in precision oncology
This study was carried out entirely within IHU RespirERA, in close collaboration with the Laboratory of Clinical and Experimental Pathology (LPCE), as well as the pulmonology and thoracic surgery departments of Nice University Hospital. It illustrates the institute’s ability to integrate cutting-edge technologies, such as ultra-fast accredited genomic sequencing, directly into the patient care pathway.
Supported by the French government through the France 2030 programme, this research fully aligns with IHU RespirERA’s ambition to develop precision oncology in respiratory health. By improving the understanding of lung cancers from their earliest stages, the institute is helping to shape future monitoring and treatment strategies, with the ultimate goal of anticipating recurrences and sustainably improving patient outcomes.
Full article: Lung Cancer 2026 – Genomic landscape of stage 0–IA lung adenocarcinoma identified by on-site reflex targeted NGS
