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Screening for Lung Cancer in Current or Past Smokers With Chronic Obstructive Pulmonary Disease

20 december 2011 uppdaterad av: University College, London

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.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

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.

Studietyp

Interventionell

Inskrivning (Faktisk)

1569

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Storbritannien
    • England
      • Cambridge, England, Storbritannien, CB23 3RE
        • Papworth Hospital
      • Coventry, England, Storbritannien, CV2 2DX
        • Walsgrave Hospital
      • Leeds, England, Storbritannien, LS1 3EX
        • Leeds General Infirmary
      • Leicester, England, Storbritannien, LE3 9QP
        • University Hospitals of Leicester NHS Trust
      • London, England, Storbritannien, SW3 6NP
        • Royal Brompton Hospital
      • London, England, Storbritannien, SW10 9NH
        • Chelsea Westminster Hospital
      • London, England, Storbritannien, WC1E 5DB
        • University College Hospital - London
      • Manchester, England, Storbritannien, M23 9LT
        • Wythenshawe Hospital
      • Sunderland, England, Storbritannien, SR4 7TP
        • Sunderland Royal Hospital
    • Northern Ireland
      • Belfast, Northern Ireland, Storbritannien, BT9 7AB
        • Respiratory Research Office Belfast City Hospital

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

  • Barn
  • Vuxen
  • Äldre vuxen

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

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

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Undersökning
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Aktiv komparator: Kontrollera
Kontrollarm
Övrig: Chest x ray
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.
Övrig: Surveillance
Screened arm
Övrig: cytology and cytometry specimen collection procedure
Samples tested and further interventions added if positive
Övrig: Chest x ray
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.
Procedur: Autofluorescence bronchoscopy
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.
Andra namn:
  • AFB
Procedur: CT scan
All patients with abnormal sputum cytology and/or cytometry will undergo low dose spiral CT without contrast.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Proportion of lung cancer that is diagnosed as stage I or II
Tidsram: 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
5 years

Sekundära resultatmått

Resultatmått
Tidsram
Uptake of screening (the proportion of patients in the surveillance arm who undergo annual screening, among those invited to attend)
Tidsram: 5 Years
5 Years
Proportion of patients in the surveillance arm who have abnormal sputum cytology
Tidsram: 5 Years
5 Years
Proportion of patients in the surveillance arm who have abnormal sputum cytometry
Tidsram: 5 Years
5 Years
Death from lung cancer
Tidsram: Up to 15 years
Up to 15 years
Proportion of failed sputum samples (i.e., where it is not possible to obtain adequate sputum samples)
Tidsram: 5 Years
5 Years
Prevalence of pre-invasive disease in patients in the surveillance arm with abnormal cytometry
Tidsram: 5 Years
5 Years
Number of patients in the surveillance arm with pre-invasive lesions who develop lung cancer locally and at remote sites within the lung
Tidsram: 5 Years
5 Years

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University College, London

Utredare

  • Studiestol: Stephen G. Spiro, University College London Hospitals

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 augusti 2007

Primärt slutförande (Faktisk)

1 mars 2011

Studieregistreringsdatum

Först inskickad

6 augusti 2007

Först inskickad som uppfyllde QC-kriterierna

6 augusti 2007

Första postat (Uppskatta)

8 augusti 2007

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

21 december 2011

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

20 december 2011

Senast verifierad

1 december 2011

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • CDR0000558413
  • CRUK-BRD/06/10
  • EU-20738
  • ISRCTN80745975

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