Assay May Allow Early Detection of Cancer
Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford and past President of ESMO (European Society for Medical Oncology). This morning I want to take a few minutes to discuss an interesting new assay, or panel of tests, that may allow us to detect lung cancer earlier.
One of the themes we have discussed many times is how we can detect cancer earlier and, in fact, prevent it. This issue is part of a continuous theme that unites all medics: How can we intervene to save more lives? We have spent time in the clinic, we have worked with drug development, and that continues to be important, of course. Should the global oncology community -- those of us involved in the direct care of cancer patients -- should we get involved more in screening and early detection? I think the answer is probably yes.
A very interesting study was reported recently in Tumor Biology by Chapman and colleagues, who describe a very interesting phenomenon, one that has been known for some time: Patients with lung cancer can have a humoral antibody response to their cancer. Not only are these autoantibodies apparent at the time of diagnosis, but they can be detected up to 5 years before the lung cancer becomes clinically apparent. You see the line of reasoning: If we can develop a sensitive and specific assay for these autoantibodies, then we may be able to detect lung cancer earlier, get stage migration, and increase the cure rate. We know that is now in the cards because of the US National Lung Cancer screening trial,a large, well-powered randomized trial [that found that screening with low-dose, helical CT scans improved lung cancer detection,] and that reduced mortality by 20% with screening. Could a relatively simple blood test contribute further?
Chapman and colleagues carefully worked through a panel of 6 or 7 autoantibodies, such as P53, SOX2, Annexin 1, NY-ESO-1, and a host of proteins. They developed a highly technically validated assay, published in a range of different clinical and scientific journals. They have shown that the panel of 6 or 7 antigens, which they use to detect these autoantibodies to lung cancer, has a sensitivity of 40% and a specificity of around 90%. To me, those figures mean that the blood test is in the range of becoming a useful screening tool for those patients who are at risk of developing lung cancer, such as those with a recent history of heavy cigarette use or those who are current smokers. I await with interest the results of prospective trials being conducted in the United States and Scotland, which will assess whether this panel of autoantibodies, this blood test in combination or in sequence with CT screening, can add value and help discriminate patients with early-stage lung cancer. Is it possible to use the blood test to screen those patients who may benefit most from CT scanning and therefore positively influence health economics as well as patient well-being? Those are 2 interesting, important studies.
The concept of using autoantibodies as a precise assay for the detection of cancer is a very interesting insight into the biology of the disease, but more importantly, a potentially effective new screening tool for those at high risk of developing lung cancer. This is worth watching. These findings may be replicated in breast, lung, and prostate cancer. One could imagine that in those diseases, a humoral immune response could similarly be mounted, and therefore there may be possibilities of adding to the screening complement in the wider cancer picture.
As always, thanks for listening.
Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford and past President of ESMO (European Society for Medical Oncology). This morning I want to take a few minutes to discuss an interesting new assay, or panel of tests, that may allow us to detect lung cancer earlier.
One of the themes we have discussed many times is how we can detect cancer earlier and, in fact, prevent it. This issue is part of a continuous theme that unites all medics: How can we intervene to save more lives? We have spent time in the clinic, we have worked with drug development, and that continues to be important, of course. Should the global oncology community -- those of us involved in the direct care of cancer patients -- should we get involved more in screening and early detection? I think the answer is probably yes.
A very interesting study was reported recently in Tumor Biology by Chapman and colleagues, who describe a very interesting phenomenon, one that has been known for some time: Patients with lung cancer can have a humoral antibody response to their cancer. Not only are these autoantibodies apparent at the time of diagnosis, but they can be detected up to 5 years before the lung cancer becomes clinically apparent. You see the line of reasoning: If we can develop a sensitive and specific assay for these autoantibodies, then we may be able to detect lung cancer earlier, get stage migration, and increase the cure rate. We know that is now in the cards because of the US National Lung Cancer screening trial,a large, well-powered randomized trial [that found that screening with low-dose, helical CT scans improved lung cancer detection,] and that reduced mortality by 20% with screening. Could a relatively simple blood test contribute further?
Chapman and colleagues carefully worked through a panel of 6 or 7 autoantibodies, such as P53, SOX2, Annexin 1, NY-ESO-1, and a host of proteins. They developed a highly technically validated assay, published in a range of different clinical and scientific journals. They have shown that the panel of 6 or 7 antigens, which they use to detect these autoantibodies to lung cancer, has a sensitivity of 40% and a specificity of around 90%. To me, those figures mean that the blood test is in the range of becoming a useful screening tool for those patients who are at risk of developing lung cancer, such as those with a recent history of heavy cigarette use or those who are current smokers. I await with interest the results of prospective trials being conducted in the United States and Scotland, which will assess whether this panel of autoantibodies, this blood test in combination or in sequence with CT screening, can add value and help discriminate patients with early-stage lung cancer. Is it possible to use the blood test to screen those patients who may benefit most from CT scanning and therefore positively influence health economics as well as patient well-being? Those are 2 interesting, important studies.
The concept of using autoantibodies as a precise assay for the detection of cancer is a very interesting insight into the biology of the disease, but more importantly, a potentially effective new screening tool for those at high risk of developing lung cancer. This is worth watching. These findings may be replicated in breast, lung, and prostate cancer. One could imagine that in those diseases, a humoral immune response could similarly be mounted, and therefore there may be possibilities of adding to the screening complement in the wider cancer picture.
As always, thanks for listening.