El Camino clinical trial aims to catch lung cancer early

A new El Camino Hospital study, launched at the beginning of this month, aims to use a genetic test to determine which smokers would benefit most from receiving regular computerized tomography scans.

The clinical trial, called REACT — an imperfect acronym for Risk Genetic and Computerized Tomography — was organized by Dr. Elwyn Cabebe, an El Camino Hospital oncologist.

Cabebe will enlist up to 200 smokers and former smokers, 50 and older, to take the Respiragene genetic test, which factors in family and personal history and examines 20 genes associated with both promoting and defending against lung cancer. The candidates will then be given a CT scan, which will search for signs of tiny tumors, called lung nodules.

If nodules are found, the smokers will be followed for up to three years, receiving appropriate treatment and follow-up scans as needed.

The study comes on the heels of a recent National Institutes of Health announcement that smokers screened for lung cancer using CT scanners are 20 percent more likely to survive than those screened with X-rays, if tumors are found.

“It definitely validated the approach we were taking for the trial,” Cabebe said, referring to the NIH announcement. He said that prior to the NIH study, there was no hard data that would suggest CT scans could catch lung cancer earlier than X-rays. “It reassured me that CT scanning is the best modality that we should be looking at for screening of our patients.”

CT scans can detect lung nodules at a much earlier stage than X-rays, giving oncologists more time to intervene.

However, Cabebe said, CT scans are expensive, expose patients to more radiation than X-rays and often find growths that are discovered to be benign only after an invasive procedure is conducted.

With REACT, Cabebe hopes to build upon the findings of the NIH by identifying those smokers and former smokers whose risk of developing lung cancer outweighs the costs and risks associated with CT scans. If his trial proves fruitful, it may end up convincing private insurance companies and Medicaid to cover the cost of preemptive CT screening for a certain subset of smokers — thus saving lives.

Currently, Cabebe said, insurance companies will only spring for the cost of a CT scan if a patient is exhibiting symptoms of lung cancer, or a doctor recommends it.

Cabebe believes that REACT could very well change the way the health care industry deals with lung cancer. “I think patients — especially smokers and ex-smokers — will be asking their providers whether it makes sense to have them undergo screening,” he said.

Dr. Laura Gottlieb, a Robert Wood Johnson Health and Society Scholar, recently wrote an op-ed for the [I San Francisco Chronicle] in response to the NIH’s announcement about the effectiveness of CT scans in catching the early stages of lung cancer.

Gottlieb, when contacted by the [I Voice] declined to comment specifically on the REACT trial.

“I think that we have to be really careful with how we use our resources,” Gottlieb said. “The biggest bang for our buck would be in tobacco prevention and cessation programs, not in CT scans for smokers.”

Cabebe said he agrees that the best way to prevent lung cancer is to avoid smoking to begin with. Those who are still smoking when they enroll in the program are required to attend smoking-cessation classes.