Cancer Center Grows Its Biorepository

Tuesday, September 20, 2016

‘Powerhouse’ repository will fuel research across disease sites

September 20, 2016

Over the past decade, thoracic surgeons and research scientists at Rush have built one of the world’s largest institutional repositories of blood and tissue samples from patients with benign and malignant thoracic tumors.

“When we started in 2004, our goal was to have a resource that could be used for two purposes,” explains biochemist Jeffrey A. Borgia, PhD.

“Our primary goal was to develop a blood test for the early detection of lung cancer. But we also wanted to develop novel blood tests to help guide treatment decisions for patients with advanced-stage thoracic malignancies and promote long-term survival for these patients.”

In the intervening years, both goals have evolved. Since the advent of low-dose CT for lung cancer screening, researchers at Rush have refocused on detection methods that will complement imaging technology. They have also built the foundation for an expansion of the biorepository that will allow them to collect samples from — and conduct research that benefits — a broader range of cancer patients.

Using biomarker profiles to improve lung cancer screening

In late 2013, the U.S. Preventive Services Task Force recommended annual lung cancer screening with low-dose CT for people between 55 and 80 with a 30-pack-year smoking history (one pack year equals smoking one pack a day for a year or two packs a day for six months, and so on).

“But we know that more than 95 percent of the nodules we identify with CT scanning will be benign,” says Christopher Seder, MD, a thoracic surgeon at Rush. “So we’re left with a dilemma: Do we put these patients through the risk and anxiety of an invasive procedure, or the risk and anxiety of watching and waiting? Or, can we find an easier way to determine whether the nodule is malignant?”

Seder, Borgia and other researchers at Rush are in the process of answering this last question. Using Rush’s biorepository, they have identified several biomarkers that may help physicians distinguish stage I non-small cell lung cancer from benign pulmonary nodules with a simple blood test.

And in November 2015, at the annual meeting of the Southern Thoracic Surgical Association, they presented research showing that a previously validated biomarker panel combined with radiographic and clinical data predicted malignancy with even greater accuracy than the biomarker panel alone had done.

Saving effort, expense — and lives

A blood assay that tests for these biomarkers is likely several years away from commercial availability. But the researchers believe this type of multifaceted approach to screening and diagnosis will eventually spare patients — and the health care system — significant effort and expense. Still, it would solve only one of the two major lung cancer screening puzzles that researchers are trying to crack.

The other, of course, is this: While patients with a 30-packyear smoking history are the only population that has been shown to benefit from screening, many patients who develop lung cancer don’t meet the screening guidelines. As a result, lung cancer is still usually diagnosed in its later stages.

So Borgia’s next project is to validate new biomarker panels with the aim of developing a “prescreening” blood test that would identify additional populations that could benefit from screening. Accordingly, Rush will soon begin collecting blood samples from patients who come in for lung cancer screenings — about 10 percent of whom fall outside of current screening guidelines.

Building a ‘powerhouse’ biorepository 

Later this year, Borgia’s team will also start collecting samples from patients with breast cancer, head and neck cancers and hematologic cancers, such as lymphoma and leukemia. And these samples will come via institutions across the Chicago area, including Rush, John H. Stroger, Jr. Hospital of Cook County, Rush Oak Park Hospital, Riverside Medical Center and DuPage Medical Group.

“Over the last year, we’ve built the foundation for a multiinstitutional, multi-disease site model that will make this a powerhouse repository,” he says. “We’re building a new facility for processing specimens and we’re putting infrastructure in place to make this facility a resource for all cancer research at Rush.”

The new infrastructure includes, most notably, the integration of repository data with patients’ electronic medical records. Thanks to an initiative led by Bala Hota, MD, MPH, Rush’s chief research information officer, the biorepository’s database will be using information from Epic to automatically associate each blood sample with clinical data collected during a specific visit.

“The associations we’re making will now be much more accurate,” Borgia says. “Which means that we will be able to better determine which treatments work best at which stages of disease.”