Pierre Massion, MD
Preliminary results of the National Lung Screening Trial in 2011 revealed that patients with lung cancer who received low-dose CT scans had a 15% to 20% lower risk of death from their disease versus those who had standard chest X-rays—a significant finding in the field that led to screening guidelines for clinical practice in the United States.
The NELSON trial results could have a similar effect in Europe. Initial findings published in The Lancet Oncology have shown that CT screening yields high specificity and sensitivity, with only a small number of interval cancers. The authors of the study noted that this has the potential to improve screening algorithms and reduce the number of missed cancers. A total of 187 of 7155 screened participants were diagnosed with 196 screen-detected lung cancers and another 34 were diagnosed with 35 interval cancers in the first and second years of screening.
“We have to remember that lung cancer treatment of any kind is much less likely to provide a cure than early detection is,” said Pierre Massion, MD. “We need to readjust the shots and emphasize, in the public and in the primary care providers in our medical community, the importance of early detection.”
Massion, co-leader, Cancer Health Outcomes and Control Research Program, Cornelius Vanderbilt Chair in Medicine, Ingram Professor of Cancer Research, professor of medicine (allergy, pulmonary, and critical care) and cancer biology, and director of the Cancer Early Detection and Prevention Initiative at Vanderbilt-Ingram Cancer Center, lectured on screening during the 2017 OncLive®
State of the Science Summit™ on Advanced Non–Small Cell Lung Cancer.
In an interview during the meeting, Massion spoke to the necessity of having more people undergo lung cancer screening, ongoing clinical trials emphasizing the importance of early detection, and how to determine who is at highest risk for lung cancer.
OncLive: Please provide an overview of your lecture on screening.
I focused on early detection because it [has been] a revolution in the field since 2011. We have heard the results of the National Lung Screening Trial, and these results are important and have led to a series of changes in guidelines that promote lung cancer screening in the high-risk population.
I talked about the implications of this, the importance of implementation, and how difficult implementation is. It took about 15 years for breast mammography screening to get into patient care and regular practices. For lung cancer, we hope to go a little faster, but, I tell you, there is a lot of hindrance and barriers to overcome. There are difficulties in unanswered questions. Who is the highest-risk population, and how can we [reach] the population who would benefit from lung cancer screening?
If you think about it, about 8% of lung cancer-related mortality could be alleviated by lung cancer screening if we follow the guidelines of the National Lung Screening Trial. That is only 8%, which is about 12,000 people out of 160,000 who die from the disease. The question is, how can we do better? This is a very important question that we are trying to answer at multiple levels. There are a lot of studies ongoing now to identify the utmost risk and to identify the people who would better benefit from lung cancer screening. Reducing the number needed to screen to save a life would be important; at the same time, we need to expend the population that was first described in the National Lung Screening Trial. If we limit ourselves to that population, we are not reaching beyond this 8% I told you about.
There is a lot of room for a better understanding of the biology of the disease, understanding how people are at higher risk and what that means, and how we can get biology to correlate for this risk assessment. This is a big area of research of interest of mine.
What types of clinical trials are being done now to answer these questions?
There are multiple trials ongoing in screening in particular, not only in the United States but in Canada, the Netherlands, and Belgium. The NELSON trial is a similar trial to the National Lung Screening Trial. It randomizes people between lung cancer CT screening with a standard of care, which is no screening, among 20,000 people or a little fewer. The results of this trial should likely be publicized next year. We are eagerly awaiting the results because [they] will have big implications for implementation of the screening approach in Europe.