Researchers have launched a clinical trial to develop a breath test, analysing molecules that could indicate the presence of cancer at an early stage, the first test of its kind to investigate multiple cancer types.
The warning signs for cancer can be vague. When people go to their GP with symptoms like heartburn or indigestion, it’s hard to say during their first appointment if cancer is to blame or if, most often, it’s something far less serious.
At the moment, being offered a simple test that points either way, or flags those who need to go to a specialist for further tests, isn’t possible across a wide range of cancers.
But Professor Rebecca Fitzgerald, a Cancer Research UK-funded scientist from the MRC Cancer Unit at the University of Cambridge, is leading a trial that’s looking to bring a potential cancer test like this closer to the clinic. And all that’s needed is a person’s breath.
A cancer breath test has huge potential to provide a non-invasive look into what’s happening in the body and could help to find cancer early, when treatment is more likely to be effective.
The Cancer Research UK Cambridge Centre is running the PAN Cancer trial for Early Detection of Cancer in Breath* in collaboration with Owlstone Medical** to test their Breath Biopsy® technology.
Breath samples from people will be collected in the clinical trial to see if odorous molecules called volatile organic compounds (VOCs) can be detected.
Professor Rebecca Fitzgerald, lead trial investigator at the Cancer Research UK Cambridge Centre, said: “We urgently need to develop new tools, like this breath test, which could help to detect and diagnose cancer earlier, giving patients the best chance of surviving their disease.
“Through this clinical trial we hope to find signatures in breath needed to detect cancers earlier – it’s the crucial next step in developing this technology. Owlstone Medical’s Breath Biopsy® technology is the first to test across multiple cancer types, potentially paving the way for a universal breath test.”
When cells carry out biochemical reactions as part of their metabolism they produce a range of VOCs. If their metabolism becomes altered, such as in cancer and various other conditions, cells can release a different pattern of VOCs. The researchers aim to identify these patterns using Owlstone Medical’s Breath Biopsy® technology.
The researchers in the trial will collect samples from 1,500 people, including healthy people as trial controls, to analyse VOCs in the breath to see if they can detect signals of different cancer types. The clinical trial will start with patients with suspected oesophageal and stomach cancers and then expand to prostate, kidney, bladder, liver and pancreatic cancers in the coming months.
The trial is recruiting patients to Addenbrooke’s Hospital in Cambridge who have been referred from their GP with these specific types of suspected cancer. They will be given the breath test prior to other diagnostic tests. Patients will breathe into the test for 10 minutes to collect a sample, which will then be processed in Owlstone Medical’s Breath Biopsy laboratory in Cambridge, UK.
By looking across cancer types, this trial will help unpick if cancer signals are similar or different, and how early it’s possible to pick these signals up. Some people will go on to be diagnosed with cancer, and their samples will be compared to those who don’t develop the disease.
If the technology proves to accurately identify cancer, the team hope that breath biopsies could in future be used in GP practices to determine whether to refer patients for further diagnostic tests.
Billy Boyle, co-founder and CEO at Owlstone Medical, said: “There is increasing potential for breath-based tests to aid diagnosis, sitting alongside blood and urine tests in an effort to help doctors detect and treat disease. The concept of providing a whole-body snapshot in a completely non-invasive way is very powerful and could reduce harm by sparing patients from more invasive tests that they don’t need.
“Our technology has proven to be extremely effective at detecting VOCs in the breath, and we are proud to be working with Cancer Research UK as we look to apply it towards the incredibly important area of detecting early-stage disease in a range of cancers in patients.”
Almost half of cancers are diagnosed at a late stage in England***. This highlights the importance of early detection, particularly for diseases like oesophageal cancer where only 12% of oesophageal cancer patients survive their disease for 10 years or more.
Dr David Crosby, head of early detection research at Cancer Research UK, said: “Technologies such as this breath test have the potential to revolutionise the way we detect and diagnose cancer in the future.
“Early detection research has faced an historic lack of funding and industry interest, and this work is a shining example of Cancer Research UK’s commitment to reverse that trend and drive vital progress in shifting cancer diagnosis towards earlier stages.”
What’s next?: The future of Owlstone’s breath test depends on what the data from this first trial shows. By the time each sample has been analysed they hope to have a fixed breath signature for cancer, or better, multiple signatures that single out different cancer types.
The biggest challenge the researchers face is getting enough patients across the variety of cancers they want to investigate. But Fitzgerald and the team are confident that the simple, non-invasive nature of the test should hopefully mean it gets some interest.
*Samples will be collected by Owlstone Medical’s CE-marked ReCIVA® Breath Sampler, and then sent to the world’s first Breath Biopsy clinical laboratory for analysis at Owlstone Medical. The research is anticipated to run until 2021, collecting some 1,500 samples from clinics at Addenbrooke’s hospital in Cambridge.
**While Owlstone will be funding the trial directly, none of this would be possible without the support and infrastructure provided by Cancer Research UK. The PAN Cancer trial is being conducted in collaboration with a team of leading cancer researchers at the Cancer Research UK Cambridge Centre, the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust. The Chief Investigator is Professor Rebecca Fitzgerald, who is co-lead of the Cancer Research UK Cambridge Centre Early Detection Programme, Professor of Cancer Prevention at the MRC Cancer Unit, and an Honorary Consultant in Gastroenterology and General Medicine at Addenbrooke’s Hospital, Cambridge.
***For all cancers (excluding non-melanoma skin cancer) diagnosed at a late stage (3 or 4) of those with a known stage at diagnosis in England (2016). Source
****Gatenby P, Caygill C, Wall C, et al. Lifetime risk of esophageal adenocarcinoma in patients with Barrett’s esophagus. World J Gastroenterol 2014;20(28):9611-7
The image included in this article was provided by Image provided by Owlstone Medical Ltd
You can view the Cancer Research UK press release in full here.