A 34-gene signature can predict the behavior of meningiomas more accurately than microscopic pathology, researchers reported in Nature Medicine. Meningiomas, the most common type of central nervous system tumor, generally are benign, but their behavior has been difficult to predict based on pathology. The study is a major step forward in managing meningiomas and could lead to more effective, personalized treatment.

Researchers developed their risk assessment using data from 173 surgically removed meningiomas, identifying the 34 genes with altered expression that appeared to drive tumor behavior. Following surgery, patients with a higher risk of recurrence may receive radiation therapy. They used the gene signature to predict risk of recurrence in a validation cohort of 1,856 meningiomas, comparing it against current classifications systems to see how well it predicted tumor behavior and outcomes.

They found that the signature identified patients with high-risk genetic alterations who may have benefitted from radiation therapy but did not receive it. It also identified patients who were received radiation treatment but whose biomarkers indicated a lower risk of recurrence. For example, as part of a clinical trial of 103 people, the signature predicted that 30% of patients who received radiation therapy had a low risk of recurrence and likely didn’t need radiation. “The gene expression biomarker improved discrimination of outcomes compared with all other systems tested (N = 9) in the clinical validation cohort for local recurrence … and overall survival,” the researchers wrote.

Although the 34-gene signature showed promising results, researchers cautioned that more studies are needed to validate the findings before it could be fully implemented in practice. Because meningiomas are more unpredictable than other tumors, precision medicine is needed to achieve better outcomes. Use of the gene signature and other biomarkers could help identify new targeted treatments beyond surgery and radiation.

Learn more about how biomarker testing can influence cancer treatment in the ONS Biomarker Database.