Screening for Lung Cancer in Current or Past Smokers With Chronic Obstructive Pulmonary Disease
A Randomised Controlled Trial of Surveillance for the Early Detection of Lung Cancer in an at Risk Group [Lung-SEARCH Trial]
RATIONALE: Screening tests or exams may help doctors find lung cancer sooner, when it may be easier to treat.
PURPOSE: This randomized clinical trial is studying screening tests or exams to see how well they work compared to usual care in finding early stage lung cancer in current or past smokers with chronic obstructive pulmonary disease.
Przegląd badań
Status
Status
Warunki
Warunki
Interwencja / Leczenie
Interwencja / Leczenie
Szczegółowy opis
OBJECTIVES:
Primary
- To show that the proportion of lung cancer diagnosed at stage I or II is significantly greater in the surveillance arm than in the control arm.
Secondary
- Establish whether sputum cytology and/or cytometry can be employed to stratify patients with chronic obstructive pulmonary disease (COPD) according to their risk of developing incidence lung cancer.
- Identify patients with pre-invasive lesions in their airways and examine the risk of developing lung cancer in patients harboring these lesions.
- Provide an opportunity to archive blood samples from patients under surveillance to enable the identification of markers of disease progression.
- Examine the compliance of regular screening among patients in this high-risk group.
- Determine the proportion of patients in which it is not possible to provide a sputum screening result.
OUTLINE: This is a randomized, controlled, multicenter study. Patients are stratified according to recruiting site, age, gender, smoking history (current vs ex-smoker) and severity of chronic obstructive pulmonary disease (COPD) (mild vs moderate). Patients are randomized to 1 of 2 arms.
- Control arm: Patients are managed according to the usual practice of their hospital or general practice for their COPD treatment. They undergo no particular investigations except those that may arise due to a change in their clinical condition. Those patients who are not diagnosed with lung cancer during the course of the study are offered a chest x-ray after 5 years of follow-up.
- Surveillance arm: Patients undergo surveillance for 5 years. A sputum sample is collected for cytology and cytometry. If the sputum sample is normal the patient is asked to provide a sputum sample annually. If the sputum sample is abnormal the patient undergoes an annual spiral CT scan followed by autofluorescence bronchoscopy. At bronchoscopy, the following samples are taken: bronchial washings, bronchial brushings, and bronchial biopsies. Bronchoscopy is repeated every 4-12 months depending upon the histology results. If an invasive lesion is found, the patient is referred for treatment via the normal hospital systems. Any remaining sputum sample is stored frozen as part of the tissue bank associated with this trial.
Peer Reviewed and Funded or Endorsed by Cancer Research UK.
Typ studiów
Typ studiów
Zapisy (Rzeczywisty)
Zapisy
Faza
Faza
- Nie dotyczy
Kontakty i lokalizacje
Lokalizacje studiów
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England
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Cambridge, England, Zjednoczone Królestwo, CB23 3RE
- Papworth Hospital
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Coventry, England, Zjednoczone Królestwo, CV2 2DX
- Walsgrave Hospital
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Leeds, England, Zjednoczone Królestwo, LS1 3EX
- Leeds General Infirmary
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Leicester, England, Zjednoczone Królestwo, LE3 9QP
- University Hospitals of Leicester NHS Trust
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London, England, Zjednoczone Królestwo, SW3 6NP
- Royal Brompton Hospital
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London, England, Zjednoczone Królestwo, SW10 9NH
- Chelsea Westminster Hospital
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London, England, Zjednoczone Królestwo, WC1E 5DB
- University College Hospital - London
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Manchester, England, Zjednoczone Królestwo, M23 9LT
- Wythenshawe Hospital
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Sunderland, England, Zjednoczone Królestwo, SR4 7TP
- Sunderland Royal Hospital
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Northern Ireland
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Belfast, Northern Ireland, Zjednoczone Królestwo, BT9 7AB
- Respiratory Research Office Belfast City Hospital
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-
Kryteria uczestnictwa
Kryteria kwalifikacji
Kryteria kwalifikacji
Wiek uprawniający do nauki
- Dziecko
- Dorosły
- Starszy dorosły
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
DISEASE CHARACTERISTICS:
Inclusion criteria:
Meets 1 of the following criteria:
- Current smoker, defined as ≥ a 20 pack year smoking history and/or 20 year duration of smoking
- Ex-smoker who has quit smoking within the past 8 years AND has ≥ a 20 pack year smoking history and/or 20 year duration of smoking
Mild to moderate chronic obstructive pulmonary disease (COPD) as defined by the GOLD criteria
- Mild COPD: FEV_1/forced vital capacity (FVC) < 70%; FEV_1 ≥ 80% of predicted*
- Moderate COPD: FEV_1/FVC < 70%; FEV_1 50-80% of predicted* NOTE: *Spirometric values will be obtained post bronchodilator according to the recommendations in the GOLD criteria
Exclusion criteria:
- Inadequate lung function (FEV_1 < 50% of predicted after bronchodilator)
PATIENT CHARACTERISTICS:
Inclusion criteria:
- Life expectancy must be at least 5 years
Exclusion criteria:
- History of malignant disease within the past 5 years except non-melanomatous skin cancers
- Other serious co-morbidity
- Evidence of severe or uncontrolled systemic diseases that, in the view of the investigator, makes it undesirable for the patient to participate in this trial
- Any disorder making reliable informed consent impossible
- Unlikely to co-operate with a 5 year follow-up
PRIOR CONCURRENT THERAPY:
- Patients may receive all concurrent therapy deemed to provide adequate care as decided by their medical doctors
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Ekranizacja
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Brak (otwarta etykieta)
Liczba ramion
Broń i interwencje
Grupa uczestników / ArmGrupa uczestników / Arm |
Interwencja / LeczenieInterwencja / Leczenie |
|---|---|
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Aktywny komparator: Kontrola
Ramię kontrolne
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Patients not diagnosed with lung cancer during the course of the study, will be offered an exit chest x-ray after 5 years or sooner if they withdraw from the trial before 5 years.
This could help identify a lung cancer that may not have been associated with symptoms earlier.
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Inny: Surveillance
Screened arm
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Samples tested and further interventions added if positive
Patients not diagnosed with lung cancer during the course of the study, will be offered an exit chest x-ray after 5 years or sooner if they withdraw from the trial before 5 years.
This could help identify a lung cancer that may not have been associated with symptoms earlier.
The bronchial tree will be inspected first under white light and then under blue light.
All areas that appear abnormal will initially be documented and only sampled when the bronchoscopic examination has been completed.
Inne nazwy:
All patients with abnormal sputum cytology and/or cytometry will undergo low dose spiral CT without contrast.
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Co mierzy badanie?
Podstawowe miary wyniku
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Proportion of lung cancer that is diagnosed as stage I or II
Ramy czasowe: 5 years
|
In the control arm, it is expected that only 15% of cancers will be detected early.
In the surveillance arm, we expect that at the time of the first screen, the detection rate of prevalence cancers will be about 3%, from data reported in CT screening studies
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5 years
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Miary wyników drugorzędnych
Miary wyników drugorzędnych
Miara wyniku |
Ramy czasowe |
|---|---|
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Uptake of screening (the proportion of patients in the surveillance arm who undergo annual screening, among those invited to attend)
Ramy czasowe: 5 Years
|
5 Years
|
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Proportion of patients in the surveillance arm who have abnormal sputum cytology
Ramy czasowe: 5 Years
|
5 Years
|
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Proportion of patients in the surveillance arm who have abnormal sputum cytometry
Ramy czasowe: 5 Years
|
5 Years
|
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Death from lung cancer
Ramy czasowe: Up to 15 years
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Up to 15 years
|
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Proportion of failed sputum samples (i.e., where it is not possible to obtain adequate sputum samples)
Ramy czasowe: 5 Years
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5 Years
|
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Prevalence of pre-invasive disease in patients in the surveillance arm with abnormal cytometry
Ramy czasowe: 5 Years
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5 Years
|
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Number of patients in the surveillance arm with pre-invasive lesions who develop lung cancer locally and at remote sites within the lung
Ramy czasowe: 5 Years
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5 Years
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Współpracownicy i badacze
Sponsor
Sponsor
Śledczy
Śledczy
- Krzesło do nauki: Stephen G. Spiro, University College London Hospitals
Publikacje i pomocne linki
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów
Rozpoczęcie studiów
Zakończenie podstawowe (Rzeczywisty)
Zakończenie podstawowe
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Oszacować)
Pierwszy wysłany
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Oszacować)
Ostatnia wysłana aktualizacja
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Dodatkowe istotne warunki MeSH
Inne numery identyfikacyjne badania
Inne numery identyfikacyjne badania
- CDR0000558413
- CRUK-BRD/06/10
- EU-20738
- ISRCTN80745975
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