Simple, cheap test may detect lung cancer in exhaled breath

By Jane Hoback

A test that works much like a Breathalyzer may be able to detect lung cancer in its early stages and could pave the way for more effective treatment of the deadly disease.

A device developed by a team of researchers from the University of Colorado Cancer Center, Technion-Israel Institute of Technology and Tel Aviv University’s Sackler Faculty of Medicine uses exhaled breath to diagnose lung cancer and identify its stage of progression.

“Lung cancer is the most frequent cause of cancer death, not only in the United States, but all over the world,” said Dr. Fred Hirsch, a professor of medicine and pathology at CU’s Cancer Center and executive director of the World Lung Cancer Organization. He led the research in Colorado. “We haven’t had the tools for early detection. I am very excited and hopeful about this approach.”

Dr. Fred Hirsch

Dr. Fred Hirsch

In the U.S., lung cancer causes more deaths than the next three most common cancers combined – colon, breast and pancreatic — according to data from the National Institutes of Health and the American Cancer Society. Nearly 400,000 Americans have lung cancer. About 224,000 new cases of lung cancer are expected to be diagnosed in 2014. And an estimated 159,000 Americans are expected to die from lung cancer in 2014, accounting for approximately 27 percent of all cancer deaths.

Hirsch points out that survival rates “are way too low.” The five-year survival rate for lung cancer is 16.6 percent, according to the National Institutes of Health. That percentage rises to 53.5 percent for cases detected when the disease is still localized in the lungs. But only 15 percent of lung cancer cases are diagnosed at an early stage.

“We are diagnosing the disease too late, and we don’t have effective therapies for the bulk of patients with advanced disease,” Hirsch said.

Low-dose CT scans on high-risk patients – such as current and former smokers – can be effective in early detection. But Hirsch said the current screening technology also results in a high rate of “false positive” nodules, that is, nodules that are actually benign but require further time-consuming and expensive testing.

Those tests can range from surgery to blood tests to bronchoscopies, for example.

“What is needed is something that helps better identify which nodules are malignant and which are benign,” Hirsch said.

Enter what researchers are calling the “electronic nose,” a highly sensitive nanotechnology chip that “sniffs out” compounds in the exhaled breath. A patient breathes into a balloon, which is embedded with the chip to analyze the compounds.

Lung cancer tumors produce chemicals called volatile organic compounds, or VOCs, which produce a specific scent. The chip detects this unique scent.

Hirsch said the approach has been studied for years but that this new sensor is based on nanotechnology that can detect “very very small molecules in the exhaled breath,” Hirsch said.

The device, developed by Hossam Haick, a professor at Technion, a leader in nanotechnology, can accurately diagnose cancer in a matter of minutes. Haick aims for the device to be small, portable and inexpensive and sophisticated enough to be able to pinpoint a tumor’s location.

Hirsch, Haick and Dr. Nir Peled of Tel Aviv University’s Sackler Faculty of Medicine presented preliminary results of their work with the device at a recent American Society of Clinical Oncology conference in Chicago.

The study of patients either diagnosed with or at risk for lung cancer showed that the device not only distinguished healthy people from people with lung cancer, but also detected different stages of the cancer. The device and subsequent analysis accurately sorted healthy people from those with early-stage lung cancer 85 percent of the time and healthy people from those with advanced-stage lung cancer 82 percent of the time, according to a Tel Aviv University release. The study also accurately distinguished between early and advanced lung cancer 79 percent of the time.

“The device could prove valuable in helping determine patients who need more intensive screening for lung cancer,” said Peled in the release. “We’re hoping to have a device that would be able to give you a go/no-go result – something’s wrong, go get an X-ray.”

Hirsch and Peled met when Peled came to Hirsch’s lab as a fellow from Israel. “Dr. Peled spent a couple of years in my lab and he introduced us to this concept,” Hirsch said. “He brought us together and we have developed this further.”

With the promising preliminary data documented, the researchers now are working on validating the results with a larger group of high-risk patients. Hirsch expects those results in two to three years.

“If that’s successful and we can reproduce the encouraging preliminary data, then it should be ready for clinical practice,” Hirsh said.

“This is a non-invasive procedure. It is a very simple, easy and relatively cheap way to screen patients,” Hirsch said. “Early detection is strongly needed.”

At the same time, better therapies are being developed to treat and cure early-stage cancer. “So the prospect of being able to detect lung cancer at an earlier stage will be a huge breakthrough,” Hirsch said.

Hirsch said many new breakthroughs in lung cancer are likely to be highlighted at the World Conference on Lung Cancer that will be held in Denver in September 2015. Some 10,000 lung cancer scientists from all over the world are expected to attend.


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