Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging. Issue 1 (14th January 2021)

• Record Type: Journal Article
• Authors: Sullivan, Frank M.; Mair, Frances S.; Anderson, William; Armory, Pauline; Briggs, Andrew; Chew, Cindy; Dorward, Alistair; Haughney, John; Hogarth, Fiona; Kendrick, Denise; Littleford, Roberta; McConnachie, Alex; McCowan, Colin; McMeekin, Nicola; Patel, Manish; Rauchhaus, Petra; Ritchie, Lewis; Robertson, Chris; Robertson, John; Robles-Zurita, Jose; Sarvesvaran, Joseph; Sewell, Herbert; Sproule, Michael; Taylor, Thomas; Tello, Agnes; Treweek, Shaun; Vedhara, Kavita; Schembri, Stuart
• Is Part Of: European respiratory journal. Volume 57:Issue 1(2021)
• Publication Date: 2021-01-14
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.00670-2020
• Languages: English
• ISSNs: 0903-1936

Abstract

The EarlyCDT-Lung test is a high-specificity blood-based autoantibody biomarker that could contribute to predicting lung cancer risk. We report on the results of a phase IV biomarker evaluation of whether using the EarlyCDT-Lung test and any subsequent computed tomography (CT) scanning to identify those at high risk of lung cancer reduces the incidence of patients with stage III/IV/unspecified lung cancer at diagnosis compared with the standard clinical practice at the time the study began. The Early Diagnosis of Lung Cancer Scotland (ECLS) trial was a randomised controlled trial of 12 208 participants at risk of developing lung cancer in Scotland in the UK. The intervention arm received the EarlyCDT-Lung test and, if test-positive, low-dose CT scanning 6-monthly for up to 2 years. EarlyCDT-Lung test-negative and control arm participants received standard clinical care. Outcomes were assessed at 2 years post-randomisation using validated data on cancer occurrence, cancer staging, mortality and comorbidities. At 2 years, 127 lung cancers were detected in the study population (1.0%). In the intervention arm, 33 out of 56 (58.9%) lung cancers were diagnosed at stage III/IV compared with 52 out of 71 (73.2%) in the control arm. The hazard ratio for stage III/IV presentation was 0.64 (95% CI 0.41–0.99). There were nonsignificant differences in lung cancer and all-cause mortality after 2 years. ECLS compared EarlyCDT-Lung plus CT screening to standard clinical care (symptomatic presentation) and was not designed to assess the incremental contribution of the EarlyCDT-Lung test. The observation of a stage shift towards earlier-stage lung cancer diagnosis merits further investigations to evaluate whether the EarlyCDT-Lung test adds anything to the emerging standard of low-dose CT. A positive EarlyCDT-Lung test, followed by CT, significantly reduced the numbers of late-stage cancers: performance of the blood test should be assessed further in a screening study where all eligible participants in the intervention arm have a CT scan https://bit.ly/32maUrB