A ‘world-first’ study backed by Roy Castle Lung Cancer Foundation could pave the way for very early detection of lung cancer as well as new treatments for it.
Led by Professor Sam Janes, the research team from University College London (UCL) has discovered new ways of understanding and identifying the earliest stages of the development of the disease.
Before lung cancer develops, precancerous lesions (or damaged tissue) are found in the airway, but only half of these will progress to become lung cancer, while others will either disappear or remain benign and non-harmful. The problem is that under the microscope, all these lesions look the same, making it difficult to establish which ones to treat and which to leave alone.
The study, published in the journal ‘Nature Medicine’, reveals that researchers have discovered the differences between lesions that will become invasive and those that are harmless, and that they can accurately predict which lesions will become cancerous.
“Our study helps to understand the earliest stages of lung cancer development, by figuring out what’s going on inside these cells even before they become cancerous. Using this information, we may be able to develop screening tests, and new treatments that could stop cancer in its tracks”.
Researchers studied biopsies of preinvasive lung cancer lesions from patients who were seen at University College London Hospitals (UCLH), conducting tests including gene expression profiling, methylation profiling and whole-genome DNA sequencing on 129 biopsy samples from 85 patients.
On average, patients were followed up for over five years after their biopsy, to see which of them developed lung squamous cell carcinoma, one of the two most common subtypes of lung cancer.
The researchers found enough differences that, by checking the lesions’ molecular profile, they could predict with near-perfect accuracy which would develop into cancer.
Further, the research team say this information could be used to help clinicians to decide whether to offer a patient surgery at a much earlier stage of the disease than is currently possible, while saving others, whose lesions are benign, from having unnecessary surgeries.
Precancerous lesions are detected by bronchoscopy, a minimally invasive test often carried out on people with a chronic cough or a history of lung cancer. While bronchoscopy is not offered to everyone at risk of getting lung cancer, the research team says that these findings could help to develop a simpler blood test to pick up the same molecular signals linked to early cancer development.
Dr Adam Pennycuick, of UCL Division of Medicine, is the co-first author of the study. He believes it could have great significance for diagnosing and treating lung cancer.
He said, “If we can use this understanding of cancer development to create new diagnostic tests, it may one day be invaluable in picking up cancer early, enabling people to access treatment in the disease process”.
The study could also lead to new treatments. Some of the genes that are expressed differently in lesions that will go onto become cancerous have previously been identified as potential drivers of lung cancer.
Co-first author Dr Vitor Teixeira (UCL Division of Medicine) added, “We are now continuing our research to further understand how these genes are driving cancer progression, and to see which ones could be targeted by new drug treatments”.
The study involved researchers at UCL Division of Medicine, UCL cancer Institute, UCLH, Wellcome Trust Sanger Institute, Boston University, The Francis Crick Institute, CRUK UK Cambridge Institute and University of St Andrews.
It was supported by Wellcome, Rosetrees Trust, Welton Trust, Garfield Weston Trust, Stoneygate Trust, UCLH Charitable Foundation, CRUK, the University College London Hospitals National Institute for Health Research Biomedical Centre, and ourselves.