New Innovations in Screening for NSCLC

James L. Mulshine, MD, discusses novel techniques for the detection of early-stage NSCLC.

Transcript:

James Mulshine:  Hello. I'm James Mulshine. I'm a thoracic medical oncologist from Rush University in Chicago. I'm involved with a variety of activities associated with development of lung cancer screening. I was asked to talk at this meeting about innovations in this space.

It's a very exciting time. As we know from the presentation of the NELSON results, we now have confirmation that the low-dose CT approach in high risk individuals that was initially reported by the IL Cap, and then on the randomized trial, the national lung screening trial has now been confirmed in another major randomized clinical trial. That is the NELSON trial that is done in the Netherlands and with Belgium and looking at a lower risk population of younger people who have less smoke exposure than the NLST, and yet they had a 10-year follow-up, a 26 percent overall mortality reduction benefit, which exceeds the findings of the NLST.

That's a good thing because there's a lot of innovations baked into the NELSON trial that we've learned since the NLST was implemented. The NLST did not involve a standardized approach to diagnostic workup. The NELSON did. They used a volumetric approach which they published in "New England Journal" some years ago.

That was associated with a more efficient diagnostic workup with a lower fraction of false positivity. That has been a concern to some in terms of the development of optimal lung cancer screening.

In addition, the NELSON group has published a whole number of other articles around their activities in low-dose CT screening. They have published as have the IL Cap about the findings of COPD in the course of lung cancer screening, in addition about the findings of coronary calcium and the significance in terms of the outcomes of those individuals.

It's very good to see all this evidence mounting that lung cancer screening has benefits not only in lung cancer, but in finding other tobacco-related diseases.

In addition, I talked about the 10-year follow-up data that was published from the Milan group in which their 4,000-person cohort was shown to have a mortality reduction benefit, even better than the NELSON.

In addition, I mentioned that the Hitachi City trial that is a epidemiological study looking at a group of people that had annual CT screening compared to a group of people that had chest X-ray screening, not in a randomized format. But still, the nine-year follow up from that, that experience showed that the CT screening population had over 50 percent mortality reduction benefit with that annual screening.

This is really confirmation that low-dose screening has a benefit, a very marked benefit. Most of these people are being cured of their lung cancer.