Breathe in air, breathe out...biomarkers

UK researchers collaborate to kick off the PAN Cancer trial in pursuit of breath-based cancer diagnosis

Kelsey Kaustinen
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CAMBRIDGE, U.K.—The more we learn about cancer, the more we're able to detect the very earliest signs of disease in the body, opening up more options for early diagnosis and a chance to head off cancer before it metastasizes. Scientists are already exploring body fluids such as blood and urine for early cancer biomarkers, but a new, even less invasive option is catching people's interest: cancer detection using the breath.
Diagnostics company Owlstone Medical has kicked off the PAN Cancer trial for Early Detection of Cancer in Breath, a clinical trial that will unite Owlstone Medical, the Cancer Research UK (CRUK) Cambridge Centre, the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust. The study will evaluate Owlstone's Breath Biopsy platform to determine its effectiveness in the early detection of bladder, breast, head and neck, kidney, esophageal, pancreatic and prostate cancers and brain tumors, and Prof. Rebecca Fitzgerald will serve as chief investigator. Fitzgerald is co-lead of the CRUK Cambridge Centre Early Detection Program, Professor of Cancer Prevention at the MRC Cancer Unit and an honorary consultant in Gastroenterology and General Medicine at Addenbrooke's Hospital, Cambridge.
“New tools that can help to diagnose cancer earlier are urgently needed and we are very pleased to collaborate with Owlstone Medical to evaluate Breath Biopsy for early detection,” Fitzgerald said in a press release. “The PAN Cancer trial forms part of our Early Detection Program, a flagship initiative of the CRUK Cambridge Centre that aims to devise better means of detecting cancer and diagnosing it in the early stages, which can lead to improved outcomes for cancer patients.”
Samples from patients who do and don't have cancer will be collected through the use of Owlstone Medical's CE-marked ReCIVA Breath Sampler and then shipped to the Breath Biopsy clinical laboratory for the company to analyze and determine whether reliable biomarkers can be isolated in the breath. This initiative will apply Owlstone's Breath Biopsy platform to analyze the samples. The platform allows for a noninvasive look at a patient's metabolome by focusing on certain metabolites known as volatile organic compounds.
As noted on Owlstone Medical's website, “In your lungs, gases are exchanged between circulating blood and inhaled fresh air. Alongside O2 and CO2, volatile metabolites also pass from the blood into the lungs extremely efficiently. These volatile organic compounds (VOCs) are exhaled and provide a source of useful biomarkers directly linked to the body's metabolism. Breath Biopsy non-invasively collects and measures VOC biomarkers from a patient's breath. As blood circulates throughout the body before returning to the lungs, the VOC biomarkers in breath provide a holistic snapshot of a person's metabolome. It takes roughly one minute for blood to flow around the entire circulatory system. By sampling breath for a minute or longer, even very low levels of systemic VOC biomarkers can be preconcentrated, collected and analyzed.”
The company argues that focusing on metabolomics offers a more accurate picture of disease, because while genomics “provides a static picture that does not capture the biological variability of disease,” a metabolimic approach focuses on “downstream molecular information, using metabolites as markers of disease activity to diagnose and stratify an individual’s treatment. After treatment selection, drug metabolites can also be measured to provides information about pharmacokinetics, to determine efficacy of the chosen treatment and monitor potential toxicity effects.”
“Positive results from the PAN Cancer trial could be game-changing in the fight against cancer; Breath Biopsy tests for cancer detection and diagnosis have the potential to greatly improve survival across a range of cancers,” remarked Billy Boyle, co-founder and CEO of Owlstone Medical. “Our Breath Biopsy platform is already being assessed in large-scale clinical trials for the noninvasive, early detection of lung and colon cancer, and it will be exciting to see how its use can be extended to other cancer types. Success in this study would make a real difference to the lives of millions of people, and supports our vision of saving 100,000 lives and $1.5 billion in healthcare costs.
“We are very proud to have the opportunity to work with these world-leading research teams on this groundbreaking trial, which could have a great impact on improving cancer survival.”
Prof. Richard Gilbertson, Li Ka Shing Chair of Oncology, director of the Cancer Research UK Cambridge Centre and head of the Department of Oncology at the University of Cambridge, added: “By 2030, the number of new cancer cases per year is expected to rise to around 22 million globally. Some cancers are diagnosed very late when there are few treatment options available. Noninvasive detection of cancer in breath could make a real difference to survival. As a Cancer Research UK Major Centre, Cambridge is working hard to realize CRUK’s vision of diagnosing more cancers earlier so that we can work closer to the day when all patients are cured of cancer.”

Kelsey Kaustinen

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