For patients with early-stage non-small cell lung cancer (NSCLC), deciding whether to pursue chemotherapy after surgery has long been a guessing game — up to half of patients see their cancer return, yet standard markers like tumor size haven't reliably predicted who benefits from additional treatment. A new 14-gene assay called RiskReveal (RazorGenomics) may change that.

Presented at the World Congress on Lung Cancer 2026 in Seoul, data from the AIM-HIGH trial showed that high-risk patients identified by the test who received adjuvant chemotherapy had a 78% reduction in the risk of recurrence or death compared to those under observation alone. A separate long-term cohort backed this up with striking overall survival numbers. The benefit held regardless of age, sex, or tumor size.

Experts are optimistic — one thoracic oncologist compared it to gene expression assays already guiding adjuvant therapy in early-stage breast cancer, suggesting RiskReveal could be on a similar path toward clinical guidelines.

By the Numbers:

• 96% vs 79% — 2-year disease-free survival with adjuvant chemo vs observation in AIM-HIGH trial high-risk patients
• 97% vs 80% — 5-year overall survival with post-op chemo vs no chemo in a separate 101-patient cohort
• 78% reduction in risk of recurrence or death with adjuvant treatment
• 87% decrease in risk of death in the long-term cohort

Why it matters: With no reliable biomarker currently guiding post-surgical treatment in early NSCLC, RiskReveal could give oncologists and patients a much-needed evidence-based tool — potentially ensuring the right patients receive chemotherapy while sparing others from unnecessary treatment.