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How A Simple Blood Test Can Help Detect Lung Cancer Earlier
Lung cancer is considered the leading cause of cancer death worldwide.
Previous research shows lung cancer causes three times as many deaths in men as prostate cancer and three times as many deaths in women as breast cancer.
The survival rate for people with lung cancer depends on the type of cancer and how quickly it is diagnosed.
For example, the overall lung cancer five-year survival rate is about 25%. However, that increases to about 63% if the cancer is detected when only in the lungs. For lung cancer that spreads to other body organs, the five-year survival rate drops to about 8%.
Now, researchers from The University of Texas MD Anderson Cancer Center have developed a blood test they say can help predict a person's risk of dying from lung cancer when combined with a lung cancer risk model.
This study was recently published in the Journal of Clinical Oncology.
Because lung cancer symptoms may not develop until it is at a later stage, only about 16% of cases are diagnosed at an early stage.
This is important because the earlier lung cancer is detected, the better a person's outlook will be.
"Lung cancer is the leading cause of cancer death worldwide," said Dr. Edwin Ostrin, an assistant professor of general internal medicine at The University of Texas MD Anderson Cancer Center and co-corresponding author of this study.
"A major reason for this is that small lung cancers usually do not lead to symptoms and around two-thirds of lung cancers are thus diagnosed when they are large and have already started to spread," Ostrin explained to Medical News Today.
"While we have made tremendous headway in treating both early and late-stage lung cancer, long-term survival is dramatically lower in more advanced lung cancer," he added. "Any tools to provide early detection of lung cancer, and thus shift the stage at diagnosis to an earlier stage, would save lives."
According to Ostrin, doctors have known since 2011 that for those at the highest risk for lung cancer — those with a significant smoking history — screening using an annual low-dose computerized tomography (CT) scan can reduce death from lung cancer by 20%.
"However, only those with the heaviest smoking history are eligible for CT-based screening," he said. "Additionally, screening finds lots of indeterminate pulmonary nodules, the vast majority of which are not cancer but still require follow-up."
For this reason, Ostrin and his colleagues have been working on a four-protein biomarker panel (4MP) for lung cancer early detection for most of the past decade.
"The blood test is a simple measurement of four proteins measured using immunoassay," he explained. "Lab tests measuring blood proteins, including tests like prostate specific antigen or even pregnancy tests are almost universally measured in a similar fashion. Immunoassays are reliable, accurate, and inexpensive, and can be rapidly deployed into a variety of healthcare settings."
Ostrin and his team first published their work in JAMA Oncology in 2018, where their findings showed the ability to identify those at risk for developing lung cancer when combined with smoking history.
"In 2021, we revealed that the same panel could help to identify which indeterminate findings found on chest CT could be cancers and which were more likely to be benign," Ostrin noted.
Then in 2022, Ostrin and his team published a Journal of Clinical Oncology paper, where, using samples from the Prostate, Lung, Colorectal, and Ovarian (PLCO) study, the 4MP improved upon a well-validated clinical lung cancer risk score (PLCOm2012) to identify those at highest risk for cancer.
"The combination of 4MP+PLCOm2012 performed better when it came to identifying those who may benefit from CT-based screening versus the current or previous criteria and thus could be a key tool to improving lung cancer screening, especially if combined with the ability of the 4MP to help sort out indeterminate findings after a CT," Ostrin said.
In this study, Ostrin said his team has now reanalyzed data from the PLCO trial, instead looking at lung cancer death.
"Individuals enrolled in PLCO were meticulously followed for as long as 20 years after enrollment," he explained. "This allowed us to evaluate how the 4MP performed not only in predicting the development of lung cancer but in predicting those who may develop lethal lung cancer. This emphasizes the potential usefulness of the 4MP in CT-based screening because those at (the) highest risk (of) dying from lung cancer would presumably benefit the most from earlier detection of cancer at an earlier stage when it is more curable."
For this study, researchers analyzed pre-diagnostic blood samples from more than 2,700 participants in the PLCO cancer screening trial. Of those analyzed, 552 participants later developed lung cancer and slightly more than 2,100 did not.
Of the 552 participants diagnosed with lung cancer during the six-year study period, 70% died from the disease.
Using hazard ratios, scientists evaluated the relationship between the combined risk scores generated by the use of the 4MP blood test and lung cancer risk model against lung cancer death incidence.
Researchers found the combination risk scores showed improved sensitivity, specificity, and positive predictive value when compared to the 2013 and 2021 U.S. Preventive Services Task Force (USPSTF) criteria for predicting lung cancer-specific mortality among individuals who smoked at least 10 pack-years.
As for the next steps for the 4MP blood test, Ostrin said they are actively working to develop it into a clinical-grade test and hope to have it ready within the next few months.
Ostrin said they will also be looking to answer other questions, such as how the 4MP blood test could be used for early lung cancer detection in people with light or no tobacco use history.
Ostrin's broader lab group is also taking parallel approaches they used for the 4MP and looking at other cancers, including pancreatic, breast, gastric, and colorectal cancer.
"In the end, we conceive of a situation where these tests could be combined into accurate and inexpensive blood tests to indicate cancer risk from a variety of cancers," he said. "Such a test may become part of a yearly assessment of health risk, much the way cholesterol and blood pressure checks are used to assess risk from cardiovascular disease."
Medical News Today also spoke with Dr. Manmeet S. Ahluwalia, the deputy director, Fernandez Family Foundation Endowed Chair in Cancer Research, chief of medical oncology, and chief scientific officer of Miami Cancer Institute, part of Baptist Health, about this study.
Ahluwalia said it is important to be able to predict a person's lung cancer early as it is often diagnosed at later stages and stage 4 lung cancer is incurable.
"Hence if using effective screening we can diagnose more people at early stages 1 and 2 we can cure more people with lung cancer," Ahluwalia said. "Estimating an individual's risk of contracting lung cancer can effectively diagnose lung cancer at earlier stages with a screening low-dose CT (LDCT) where treatment modalities offer a more concrete solution."
"The proposed model of incorporating biomarker and subject characteristics offers improved means for individualized risk assessment for lung cancer, compared to the current USPSTF criteria," he added.
Tecentriq Doubles 2-Year Survival Rate In Certain Patients With NSCLC
Tecentriq, compared with chemotherapy, improved survival while maintaining quality-of-life in patients with non-small cell lung cancer considered ineligible for platinum-based chemotherapy.
Tecentriq (atezolizumab) nearly doubled the two-year survival rate while maintaining quality of life in patients with non-small cell lung cancer (NSCLC) who were ineligible for treatment with a platinum-containing regimen, recent findings suggest.
"These data support (Tecentriq) monotherapy as a potential first-line treatment option for patients with advanced NSCLC who are ineligible for platinum-based chemotherapy," the researchers wrote in the study published in The Lancet.
According to the study's introduction, advancements have been made in the use of immunotherapy for patients with advanced or metastatic NSCLC, but data primarily focused on patients with little to no restrictions on activities of daily living (so considered fully active or unable to do strenuous activities) and in those 65 years or younger.
In the phase 3 IPSOS study, researchers compared first-line therapy (first treatment given as part of a set of treatments) with Tecentriq versus single-agent chemotherapy in 453 patients with stage 3B or 4 NSCLC who met one of two criteria:
Patients were randomly assigned either Tecentriq (302 patients) or chemotherapy (151 patients) with vinorelbine or gemcitabine. Of note, patients assigned Tecentriq underwent treatment every three weeks, whereas those assigned chemotherapy received treatment at three-weekly or four-weekly cycles.
The primary focus of this study was overall survival, defined as the time from treatment assignment to all-cause death, according to the study's listing on ClinicalTrials.Gov. Researchers also monitored patients for any side effects related to treatment.
Patients assigned Tecentriq had a median overall survival of 10.3 months compared with 9.2 months in those assigned chemotherapy. The two-year survival rate for the Tecentriq group was 24% versus 12% in the chemotherapy group.
Tecentriq also either stabilized or improved symptoms and health-related quality-of-life measures compared with chemotherapy.
There were fewer severe or worse side effects related to treatment with Tecentriq versus chemotherapy (16% versus 33%), in addition to fewer treatment-related deaths (1% versus 3%).
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Lung Cancer And Coughing Up Blood
Coughing up blood from your respiratory tract is referred to as hemoptysis. It can occur at any stage of lung cancer but can also happen for other reasons.
Coughing up blood is not generally associated with any particular stage of lung cancer over another, according to the American Cancer Society.
It is not a reliable indicator of life expectancy for someone with lung cancer.
However, most symptoms of lung cancer appear when the disease has already reached an advanced stage.
In 2020, the American Lung Association noted that 23% of people with lung cancer receive a diagnosis in the early stage, when the 5-year survival rate is 59%, although early diagnosis rates are rising in the United States.
Meanwhile, 47% of people with lung cancer receive a diagnosis in a late stage, when the 5-year survival rate is 6%.
Figures from 2013–2019 suggested that the chance of living another 5 years with any type of lung cancer and a diagnosis at any stage was 25.4% on average.
However, the outlook will depend on a range of factors, including age and the type of lung cancer a person has, as some are more aggressive than others.
Your oncologist can provide a more accurate assessment of your situation, although life expectancy estimation is not an exact science.
Bleeding from the lungs is a common complication of lung cancer.
It can happen at any stage and can range from a few bright red spots or blood-tinged sputum to severe bleeding that can be fatal.
One factor a doctor will consider when assessing the severity of bleeding is the amount of blood produced.
There is no standard way to categorize the amounts or to decide what is most serious, but one example may be as follows:
If you produce more than 2 teaspoons of blood, you should seek urgent medical help. However, doctors typically only consider massive bleeding — also called a pulmonary hemorrhage — to be immediately life threatening.
Cancer can have many effects on the body, so it is not possible to predict the stage of cancer by how much blood a person produces. For example, the location of a tumor and whether it has damaged a blood vessel may affect how likely a person is to bleed from the lungs.
Symptoms don't always appear in the early stage of lung cancer, but the following are often the first ones people notice:
Coughing up blood can also be a sign of metastatic cancer or cancer that has spread from another part of the body to the lungs.
Cancers that commonly metastasize to the lungs include:
Metastatic cancer reaching distant parts of the body from where it started is always a later stage cancer. The life expectancy is lower than for early stage cancer, but treatment can still be effective in some cases.
Coughing up blood does not always mean that you have lung cancer.
Other possible causes include:
While these conditions are associated with coughing up blood, your doctor will perform a diagnosis to pinpoint the cause and suggest an appropriate treatment plan.
Unexplained coughing up blood is always a cause for concern and a reason to contact your doctor.
You should seek medical advice as soon as possible if you:
You can cough up blood at any stage of lung cancer, and the severity does not necessarily match the stage. Only diagnostic tests can show what stage the cancer has reached.
What are the signs of end stage lung cancer?Stage 4 lung cancer is when cancer has spread from the lungs to other parts of the body. Symptoms include bone pain, jaundice or yellowing of the eyes, swollen lymph nodes, dizziness, and so on, depending on where the cancer has spread.
What color blood do you cough up with lung cancer?You may notice bright red blood or pink, streaked, or rust-colored phlegm.
Coughing up blood from your respiratory tract (hemoptysis) is a common symptom of lung cancer.
It's not generally associated with any particular stage of lung cancer and does not estimate life expectancy with lung cancer.
Seek medical advice if you're coughing up blood. Early treatment is more likely to be effective whether it is due to lung cancer or another condition.
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