EFIRM Liquid Biopsy Research Laboratory: Early Lung Cancer Assessment

项目概要/摘要： 计算机断层扫描（CT）是目前检测临床前肺癌最敏感的测试。的 国家肺筛查试验（NLST）表明，常规低剂量CT筛查可减少肺癌 死亡率相对于胸部X线摄影降低了20%。然而，CT使用的增加也导致了 发现了估计200万个筛查和偶然发现的不确定的肺结节（IPN）。 这些直径小于30 mm的结节大部分是良性的，但也有一部分具有恶性潜能。 迫切需要更好地区分患有良性疾病的个体和那些应该 进行侵入性诊断测试。 液体活检已经进入癌症词典，作为血液或血液中肿瘤生物标志物的参考。 其他容易获得的反映癌症存在和生物学的生物标本。到完全成熟的液体 活组织检查处于早期癌症评估的最前沿，必须解决两个前沿问题。一是发展 （发现和验证）用于早期检测的全面个性化癌症特异性组学靶标。的 第二是技术的进步和完善，可以检测到这些最早的脱落 循环目标该应用程序是EFIRM-液体活检研究实验室（E-LBRL）目标的第2阶段 推进不确定性肺结节（IPN）早期癌症评估的两个基本前沿： 肺癌的早期诊断 我们的合作伙伴关系将肺癌生物学家，临床医生和生物统计学家的专业知识与 行业工程师，聚集在新的液体活检技术"EFIRM-Liquid biopsy（eLB）"。 作为eLB性能的补充，在E-LBRL的第一阶段，我们发现了一种新物种 超短和单链的无细胞DNA（uscfDNA），并有助于大量的 宽范围cfDNA（BRcfDNA）池。与循环肿瘤DNA不同，循环肿瘤DNA在早期状态下是罕见或不存在的， uscfDNA代表癌症的整体/系统变化， IPN的现状。此外，由于它们的物理特性，这些BRcfDNA生物标志物是最佳的， eLB平台。 我们假设来自恶性肿瘤相关BRcfDNA的信号可以与恶性肿瘤整合， 相关的体细胞突变，分化的甲基化区域，miRNA和放射组学成像在一个整合的 模型称为IPN. CA，以允许IPN的最早癌症评估。我们的行业合作伙伴与 生物标志物参考实验室将单个eLB检测转换为多重阵列，以进行CLIA确认。eLB- IPN. CA及其相关输入将是用于早期癌症的临床可部署的实验室开发测试（LDT） 评估IPN。

Project Summary/Abstract: Computed tomography (CT) is currently the most sensitive test for detecting preclinical lung cancer. The National Lung Screening Trial (NLST) demonstrated that routine low-dose CT screening reduces lung cancer mortality by 20% relative to chest radiography. However, the increased use of CT has also resulted in the discovery of an estimated 2 million screened and incidentally detected indeterminate pulmonary nodules (IPNs). These nodules, less than 30 mm in diameter, are largely benign but a proportion possess malignancy potential. Methods are urgently needed to better differentiate between individuals with benign disease and those should undergo invasive diagnostic testing. Liquid biopsy has found its way into the cancer lexicon as a reference to tumor biomarkers within blood or other readily accessible biospecimens that reflect the presence and biology of cancer. To fully mature liquid biopsy at the forefront of early cancer assessment, two frontiers must be addressed. The first is the development (discovery and validation) of comprehensive personalized cancer-specific omics targets for early detection. The second is the advancement and refinement of technologies that can detect the earliest shedding of these circulating targets. This application is Phase 2 of the EFIRM-Liquid Biopsy Research Laboratory (E-LBRL) aims to advance these two essential frontiers for early cancer assessment of indeterminate pulmonary nodules (IPNs): early detection of lung cancer. Our partnership interweaves the expertise of lung cancer biologists, clinicians, and biostatisticians with industry engineers, converging on the novel liquid biopsy technology “EFIRM-Liquid biopsy (eLB)”. Complementary to the performance of eLB, during the Phase 1 of E-LBRL, we have discovered a novel species of cell-free DNA which are ultrashort and single-stranded (uscfDNA) and contribute to a population of a large pool of Broad Range cfDNA (BRcfDNA). Unlike circulating tumor DNA which are rare or absent in early states, the uscfDNA represent global/systemic changes in cancer and can be harnessed to detect the malignancy status of the IPN. Additionally, due to their physical characteristics, these BRcfDNA biomarkers are optimal for the eLB platform. We hypothesize that signals from malignancy associated BRcfDNAs can be integrated with malignancy associated somatic mutations, differentiated methylated regions, miRNA and radiomic imaging in an integrated model termed IPN.CA to permit the earliest cancer assessment of IPN. Our industry partner together with a Biomarker Reference Lab will convert individual eLB assays to multiplex arrays for CLIA-qualification. The eLB- IPN.CA and its associated inputs will be a clinically deployable Laboratory Developed Test (LDT) for early cancer assessment in IPN.