# TRACERx

Source: https://onco.cc/trials/tracerx/  
OnCo record `tracerx` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The British study that followed lung cancers through time and space, region by region, and showed that a tumour is not one thing: the late-arriving, scattered changes are the ones that predict relapse.

## Summary

TRACERx, led by Charles Swanton at the UCL Cancer Institute and the Francis Crick Institute with Mariam Jamal-Hanjani as lead clinician, took multiple regions from each resected lung cancer and sequenced them. The first 100 tumours, across 327 regions, showed that driver mutations in EGFR, MET, BRAF and TP53 were almost always clonal, but that heterogeneous drivers arriving later in evolution were present in more than three quarters of tumours, and that elevated copy-number heterogeneity carried a hazard ratio of 4.9 for recurrence or death.

The 421-patient analysis found 22 of 40 common cancer genes under significant subclonal selection in adenocarcinoma, subclonal whole-genome doubling in 19 percent of tumours, and, strikingly, that 8 percent of lung adenocarcinomas in people with a smoking history carried no tobacco mutational signature and behaved molecularly like never-smoker tumours. The PEACE autopsy programme extended the work to death: 501 samples from 24 people covering 70 percent of the metastases visible on imaging showed that in 62.5 percent of patients several primary subclones disseminated independently, and that more than half the metastases sampled had been seeded by other metastases rather than by the primary. The same group's air pollution work then showed oncogenic EGFR variants in 18 percent of histologically normal lung tissue, and a mechanism by which particulates promote them.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: TRAcking non-small cell lung Cancer Evolution through therapy (Rx); NCT01888601
- Tags: uk; lung; tumour-evolution
- Registry id: NCT01888601
- Phase: observational
- Setting: Multiregion whole-exome and whole-genome sequencing of resected non-small-cell lung cancer, with longitudinal circulating tumour DNA and, through the PEACE autopsy programme, sampling at death
- Sponsor: University College London, funded by Cancer Research UK
- Enrolled: 421
- Result: Copy-number heterogeneity predicted recurrence or death with a hazard ratio of 4.9; 8 percent of adenocarcinomas in people with a smoking history carried no tobacco signature; in the autopsy programme more than half the metastases sampled were seeded by other metastases.

## Sources

- New England Journal of Medicine 2017: https://europepmc.org/article/MED/28445112
- Nature 2023: https://europepmc.org/article/MED/37046096
- Nature 2026 (PEACE): https://europepmc.org/article/MED/42056508
- NIHR Be Part of Research: https://bepartofresearch.nihr.ac.uk/results/search-results?query=TRACERx%20lung

## Connected records

- cancers: [Adenocarcinoma of the lung](https://onco.cc/cancers/lung-adenocarcinoma/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/)
- institutions: [The Francis Crick Institute](https://onco.cc/institutions/francis-crick/), [University College London Hospitals / UCL Cancer Institute](https://onco.cc/institutions/uclh/)
- people: [Charles Swanton](https://onco.cc/people/charles-swanton/)

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JSON: https://onco.cc/api/v1/entities/tracerx.json