Beating the odds

MD Anderson’s Moon Shots Program has launched a number of bold projects constituting an all-out assault on cancer. Lung cancer, for example, one of the eight cancers identified in the first round of moon shots, is under attack by a team of experts determined to use early detection to outsmart the deadly disease, the second most common cancer in men and women.

Flagship project

The lung cancer moon shot’s inaugural efforts focus on developing biomarkers that will make it easier to detect lung cancer in its earlier stages. Leaders representing cancer prevention, internal medicine, oncology, radiology, quantitative science and experimental therapeutics are collaborating to create an integrated, comprehensive program that involves an applicable clinical risk prediction model, identifying predictive biomarkers in the airway and blood, and developing advanced imaging techniques.

“The odds are stacked against you when it comes to detecting lung cancer,” says Samir Hanash, M.D., Ph.D., professor in the Department of Clinical Cancer Prevention at MD Anderson and one of several investigative leaders working on this flagship project. “The best way to gain the advantage is to develop strategies that detect cancer in its earliest stages.”

Hanash is the head of the Red and Charline McCombs Institute for the Early Detection and Treatment of Cancer — an institute comprising seven centers with leaders in biomedical research focused on molecular-based approaches to cancer diagnosis and management.  He brings a breadth of knowledge to the team with his translational efforts aimed at developing marker panels for cancer risk, detection, treatment response and recurrence.

Early bird strategies

“Developing biomarkers shares some of the same challenges as developing drugs,” says Hanash, who also co-leads the early detection center, an integral part of the lung flagship project. “It requires a road map from discovery to validation for defined clinical applications.”

A multidisciplinary advisory board and a clinical screening team will provide expertise while four biomarker teams will focus on clinical and genomic risk stratification, airway changes, advanced imaging and blood-based markers.

Identifying those at risk

The goal of the clinical and risk stratification team is to identify a high-risk population for cost-effective surveillance, screening and detection of early stage patients.  This team will use preliminary risk prediction models based on cancer control studies and existing epidemiological data and biomarkers to identify people potentially at high risk.  The project will also recruit smokers from MD Anderson’s Lung Cancer Screening Program. The program was launched in 2010 after the National Cancer Institute’s National Lung Screening Trial (NLST) found a 20% reduction in lung cancer mortality for study participants who received spiral CT scans.

“The NLST results marked the most significant progress we’ve made in lung cancer screening in years,” says Reginald Munden, M.D., a professor in the Department of Diagnostic Radiology and MD Anderson’s principal investigator on the national clinical trial.

Detecting airway changes

Emerging research has associated lung cancer risk with characteristic changes in the airway lining, or epithelium. The airway changes team is developing risk markers through airway changes detected from nasal and saliva swabs. Samples will be collected from high-risk patients enrolled in MD Anderson’s early detection platform lung cancer trial.

Seeking better screening, blood-based markers

The advanced imaging team will concentrate on screening technology and assessing tumor response.  The fourth team focuses on identifying blood-based markers, says Hanash.

“We want to develop an affordable, effective blood-based test to detect lung cancer in its earliest stages,” he says.

Hanash, whose research focuses on multiple cancers, anticipates the next two to three years will be intense as he and colleagues at the McCombs Institute continue this aggressive approach, leading the effort toward early detection. By developing biomarkers that detect lung cancer risk — before the disease occurs — and using them to detect the disease earlier, he hopes history, when it comes to cancer, will prove that hard work and perseverance really do help the early bird catch the worm.