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Crawford EL, Levin A, Safi F, Lu M, Baugh A, Zhang X, Yeo J, Khuder SA, Boulos AM, Nana-Sinkam P, Massion PP, Arenberg DA, Midthun D, Mazzone PJ, Nathan SD, Wainz R, Silvestri G, Tita J, Willey JC. Lung cancer risk test trial: study design, participant baseline characteristics, bronchoscopy safety, and establishment of a biospecimen repository. BMC Pulm Med 2016; 16:16. [PMID: 26801409 PMCID: PMC4722707 DOI: 10.1186/s12890-016-0178-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Lung Cancer Risk Test (LCRT) trial is a prospective cohort study comparing lung cancer incidence among persons with a positive or negative value for the LCRT, a 15 gene test measured in normal bronchial epithelial cells (NBEC). The purpose of this article is to describe the study design, primary endpoint, and safety; baseline characteristics of enrolled individuals; and establishment of a bio-specimen repository. METHODS/DESIGN Eligible participants were aged 50-90 years, current or former smokers with 20 pack-years or more cigarette smoking history, free of lung cancer, and willing to undergo bronchoscopic brush biopsy for NBEC sample collection. NBEC, peripheral blood samples, baseline CT, and medical and demographic data were collected from each subject. DISCUSSION Over a two-year span (2010-2012), 403 subjects were enrolled at 12 sites. At baseline 384 subjects remained in study and mean age and smoking history were 62.9 years and 50.4 pack-years respectively, with 34% current smokers. Obstructive lung disease (FEV1/FVC <0.7) was present in 157 (54%). No severe adverse events were associated with bronchoscopic brushing. An NBEC and matched peripheral blood bio-specimen repository was established. The demographic composition of the enrolled group is representative of the population for which the LCRT is intended. Specifically, based on baseline population characteristics we expect lung cancer incidence in this cohort to be representative of the population eligible for low-dose Computed Tomography (LDCT) lung cancer screening. Collection of NBEC by bronchial brush biopsy/bronchoscopy was safe and well-tolerated in this population. These findings support the feasibility of testing LCRT clinical utility in this prospective study. If validated, the LCRT has the potential to significantly narrow the population of individuals requiring annual low-dose helical CT screening for early detection of lung cancer and delay the onset of screening for individuals with results indicating low lung cancer risk. For these individuals, the small risk incurred by undergoing once in a lifetime bronchoscopic sample collection for LCRT may be offset by a reduction in their CT-related risks. The LCRT biospecimen repository will enable additional studies of genetic basis for COPD and/or lung cancer risk. TRIAL REGISTRATION The LCRT Study, NCT 01130285, was registered with Clinicaltrials.gov on May 24, 2010.
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Affiliation(s)
- E L Crawford
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - A Levin
- Department of Biostatistics, Henry Ford Hospital System, Detroit, MI, USA
| | - F Safi
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - M Lu
- Department of Biostatistics, Henry Ford Hospital System, Detroit, MI, USA
| | - A Baugh
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - X Zhang
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - J Yeo
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - S A Khuder
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - A M Boulos
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA
| | - P Nana-Sinkam
- Ohio State University James Comprehensive Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - P P Massion
- Thoracic Program, Vanderbilt Ingram Cancer Center, Nashville, TN, USA
| | | | | | | | - S D Nathan
- Inova Fairfax Hospital, Falls Church, VA, USA
| | - R Wainz
- The Toledo Hospital, Toledo, OH, USA
| | - G Silvestri
- Medical University of South Carolina, Charleston, SC, USA
| | - J Tita
- Mercy/St. Vincent's Hospital, Toledo, OH, USA
| | - J C Willey
- Department of Pulmonary and Critical Care, The University of Toledo Medical Center, Toledo, OH, USA.
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Busse WW, Wanner A, Adams K, Reynolds HY, Castro M, Chowdhury B, Kraft M, Levine RJ, Peters SP, Sullivan EJ. Investigative bronchoprovocation and bronchoscopy in airway diseases. Am J Respir Crit Care Med 2005; 172:807-16. [PMID: 16020805 PMCID: PMC2718402 DOI: 10.1164/rccm.200407-966ws] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Basic and clinical research strategies used for many lung diseases have depended on volunteer subjects undergoing bronchoscopy to establish access to the airways to collect biological specimens and tissue, perhaps with added bronchoprovocation in asthma syndromes. These procedures have yielded a wealth of important scientific information. Since the last critical review more than a decade ago, some of the techniques and applications have changed, and untoward events have occurred, raising safety concerns and increasing institutional review scrutiny. OBJECTIVES AND METHODS To reappraise these investigational methods in the context of current knowledge, the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health convened a working group to review these procedures used for airway disease research, emphasizing asthma and chronic obstructive pulmonary disease. MAIN RESULTS The group reaffirmed the scientific importance of investigative bronchoscopy and bronchoprovocation, even as less invasive technologies evolve. The group also considered the safety of bronchoscopy and bronchoprovocation with methacholine and antigen to be acceptable for volunteer subjects and patients, but stressed the need to monitor this closely and to emphasize proper training of participating medical research personnel. Issues were raised about vulnerable volunteers, especially children who need surrogates for informed consent. CONCLUSION This review of investigative bronchoscopy and bronchoprovocation could serve as the basis for future guidelines for the use of these procedures in the United States.
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