Purpose: DNA damage checkpoints are initiated by its sensor proteins of the phosphoinositide-3-kinase^related protein kinase family, including ataxia-telangiectasia mutated, ataxia-telangiectasia and Rad3-related, and DNA-dependent protein kinase catalytic subunit (DNA-PKcs). We hypothesized that polymorphisms in these genes may alter the regulation of DNA repair and the risk of lung cancer. Experimental Design: We genotyped 12 tagging single nucleotide polymorphisms (tSNP) in these three phosphoinositide-3-kinase^related protein kinase genes in 500 incident lung cancer cases and 517 controls in a Chinese population by using the Illumina SNP genotyping BeadLab platform. Results: Single locus analyses revealed that some of the heterozygotes or variant homozygotes of DNA-PKcs tSNPs were associated with decreased risks of lung cancer compared with their wild-type homozygotes. In the combined analyses of two tSNPs (rs8178085 and rs12334811) with approaching dose-dependent effect on lung cancer predisposition, subjects carrying two to four risk genotypes were associated with a 43% decreased lung cancer risk compared with subjects carrying zero to one risk genotypes (adjusted odds ratio, 0.53; 95% confidence interval, 0.35-0.80). Moreover, the decreased risk associated with the combined genotypes of rs8178085 and rs12334811was slightly more pronounced in nonsmokers and in carriers with ataxia-telangiectasia mutated rs228591 variant allele or ataxia-telangiectasia and Rad3-related rs6782400 wild-type homozygous genotype. Conclusion:These results indicate, for the first time, that tSNPs in DNA-PKcs may play a protective role in lung cancer development.Maintenance of genome stability is essential for avoiding the passage to neoplasia. DNA lesions that are not properly repaired before cell division can be mutagenic, resulting in mutations and the formation of a precancerous cell (1, 2).A wealth of information has been accumulated on DNA repair mechanisms over the past 50 years. Genetic defects disturbing these mechanisms can cause inherited syndromes that are characterized by hypersensitivity to specific DNA-damaging agents and predisposition to cancer (3). Although the repair of different types of DNA lesion relies on different sets of proteins, the various forms of DNA damage nevertheless trigger common response signals, such as DNA damage ''checkpoints'' (4, 5).Before detecting a specific type of DNA lesions, the cell must sense very low levels of DNA damage in the genome. The rapidity and potency of this DNA damage response demand very sensitive signal transduction cascades, initiated by the sensor proteins of the phosphoinositide-3-kinaserelated protein kinase (PIKK) family, including ataxiatelangiectasia mutated (ATM), ataxia-telangiectasia and Rad3-related (ATR), and DNA-dependent protein kinase catalytic subunit refs. 4,6). ATM and DNA-PKcs respond mainly to DNA double-strand breaks, whereas ATR is activated by ssDNA and stalled DNA replication forks (7). Recently, Falck et al. (8) identified related, c...