Breath analysis identifies which lung cancer patients will respond to immunotherapy
An impressive new study is suggesting a simple breath analysis can accurately predict whether lung cancer patients will positively respond to novel immunotherapy treatments. Unlike current methods, which involve studying tissue samples, the new “eNose” device can offer diagnostic advice in less than 60 seconds.
“The introduction of immunotherapy has dramatically improved the treatment of advanced stage non–small cell lung cancer but unfortunately it is only effective in a subset of patients, which was about 20 percent when we started the study,” explains Michel van den Heuvel, describing the origins of the research.
Underpinning this new research was the frustrating lack of consistency in identifying which patients will best respond to new immunotherapy treatments, called checkpoint inhibitors. The only method currently available to clinicians is testing tissue samples for a particular protein targeted by the treatment. This is time-consuming, invasive, and slows down the entire diagnostic process.
The new study utilized an electronic nose device called the SpiroNose. This technology can effectively measure volatile organic compounds (VOCs) in exhaled breath. The vast majority of our breath comprises nitrogen, oxygen, carbon dioxide and water, but about one percent is composed of VOCs, and these VOCs can act as effective biomarkers to a number of different metabolic processes.
This eNose technology involves a patient exhaling slowly into the device and a single breath is analyzed by several sensors that measure different groups of molecules.
“The sensor readings are sent directly to and stored at an online server for real-time processing of the data and for ambient air correction because the air that you exhale is influenced by the air that you inhale,” says Rianne de Vries, joint first author on the new study, and CEO of Breathomix, the company currently producing the eNose technology. “The measurement takes less than a minute, and the results are compared to an online database where machine-learning algorithms immediately identify whether or not the patient is likely to respond to anti-PD1 therapy.”
The current research tracked 143 patients with advanced non-small cell lung cancer before, during, and after checkpoint inhibitor immunotherapy treatment. A specific VOC breath-print was identified allowing the eNose device to accurately predict which patients would respond positively to the treatment, and which patients would not. At the end of the study the researchers claim the current method can identify who will or will not respond to the treatment with 85 percent accuracy.
Before the device can be widely deployed in clinical environments the researchers will verify these early results in a large prospective multi-center study. Michel van den Heuvel is convinced not only could this electronic nose method help identify lung cancer patients suitable for immunotherapy, but also potentially usher in a new wave of precision medicine guided by this kind of diagnostic device.
“We are convinced that this study merely scratches the surface,” says van den Heuvel. “It represents the first introduction of modern precision medicine, namely that molecular fingerprints can be easily obtained and quickly analyzed on the spot. This truly offers new possibilities for the individual patient and the doctor. The power of this eNose system is that it has been properly validated, both technically and clinically, which is essential. We believe that analysis of exhaled breath is going to become an important diagnostic tool and will guide future treatment in oncology as well as in many other diseases.”
The new research was published in the journal Annals of Oncology.