Mesothelioma is an aggressive cancer with an average prognosis of 12-21 months, but studies are uncovering new approaches to getting patients the personalized medical care they need to live longer.

A recent Baylor College of Medicine study aimed to create a model for mesothelioma to help predict how the patient’s cancer will behave. The model is based on gene signatures similar to the ORACLE model used for lung adenocarcinoma, a type of non-small cell lung cancer (NSCLC).

By understanding the genetic characteristics of mesothelioma tumors, doctors can determine the best treatments to use and potentially improve patient outcomes.

Learn how the study team developed the new PRACME model and what it could mean for the mesothelioma community.

Understanding the ORACLE Model

ORACLE (outcome risk-associated clonal lung expression) looks at how certain genes in different parts of tumor affect cancer behavior. The ORACLE model can accurately predict survival outcomes in patients with NSCLC.

However, this model has a harder time predicting the behavior of cancers with high intratumor heterogeneity (ITH). ITH refers to the genetic variations that can be found within a single tumor. Essentially, different conditions and stressors in each area of the tumor can affect how their genes and cancer cells function and behave.

ITH is linked to various cancer traits like:

  • Drug resistance
  • Immune suppression
  • Instability
  • Poor prognosis
  • Tumor growth and spread

Mesothelioma and lung cancer both show high ITH. This variability can make them challenging to treat because different parts of the tumor may respond differently to the same therapy.

Approximately 50% of mesothelioma patients develop resistance to chemotherapy due to ITH. This happens when some cancer cells are able to survive and multiply, leading to drug-resistant tumors.

ORACLE helps by using genetic information from various parts of these tumors to find common patterns. These patterns help predict how the cancer will behave, making it easier to plan effective treatments.

Learn more about mesothelioma cancer and how it’s treated in our Free Mesothelioma Guide.

PRACME: The Breakthrough Mesothelioma Model

Recognizing the genetic parallels between lung cancer and pleural mesothelioma (a type of this cancer that forms in the lining of the lungs), the researchers set out to adapt the ORACLE model for mesothelioma.

Researchers examined 78 tumor samples from 26 mesothelioma patients who underwent pleural mesothelioma surgery between 2017 and 2019.

These samples contained the Q4 genes, which are also present in lung cancer and have high ITH, with tumors differing greatly from one patient to the next.

By combining the Q4 samples with mesothelioma genes from another database, researchers determined a set of 29 genes known as PRACME (Prognostic Risk Associated Clonal Mesothelioma Expression) that could help them predict patient outcomes.

How Does the PRACME Model Work?

PRACME evaluates how specific genes are expressed in mesothelioma tumors and provides an overall score for doctors to interpret.

Here’s what the study researchers discovered about PRACME scores:

  • Patients with low to intermediate PRACME scores tended to have a longer life expectancy post-surgery compared to those with higher scores.
  • Tumors with high PRACME scores were more aggressive and also had higher ITH.
  • Scores were highest in patients with sarcomatoid mesothelioma, which is known for having the poorest prognosis of all three cell types.
  • Patients who were exposed to asbestos had higher PRACME scores and lower life expectancies.
  • Doctors could use PRACME scores to tailor patient treatment plans.

Overall, the PRACME model was found to have significant value for predicting how mesothelioma cancer progresses and responds to certain treatments.

We Can Help You Get Personalized Mesothelioma Care

At Mesothelioma Hope, we’re dedicated to providing personalized medical guidance and supportive care to patients and their families, especially as new advancements like this study are made.

Our nurses and Patient Advocates are here to help you:

  • Find experienced mesothelioma doctors to confirm a diagnosis and determine your treatment options
  • Pursue financial assistance to pay for medical care and other expenses
  • Get the support you need at every step of your cancer journey

Call us at (866) 608-8933 now or get essential information for navigating this cancer in our Free Mesothelioma Guide.

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Laura WrightWritten by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 15 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

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  1. Lin, Y., Burt, B.M., Lee, HS. et al. (2024). Clonal gene signatures predict prognosis in mesothelioma and lung adenocarcinoma. npj Precision Oncology. Retrieved April 16, 2024, from

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