Personalized Lung Cancer Risk Assessment Using a Blood-Based Biomarker Panel

Get Permission

In a study reported in the Journal of Clinical Oncology, Fahrmann et al found that a four-component blood-based biomarker panel showed predictive ability for the development of lung cancer. Prediction was improved when the panel was used in conjunction with the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial 2012 model (PLCOm2012) of risk assessment for lung cancer screening eligibility.

Study Details

The study involved analysis of 1,299 sera collected preceding lung cancer diagnosis and 8,709 noncase sera from the PLCO Cancer Screening Trial. Specimens were analyzed with a four-marker protein panel (4MP) consisting of the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment.

Key Findings

Use of the 4MP alone was associated with a receiver operating characteristic area under the curve of 0.79 (95% confidence interval [CI] = 0.77–0.82) for case sera collected within 1 year preceding diagnosis and 0.72 (95% CI = 0.69–0.75) among case sera collected within 1 to 6 years preceding diagnosis (all case sera). The combined 4MP plus PLCOm2012 model yielded an area under the curve of 0.85 (95% CI = 0.82–0.88) for case sera collected within 1 year preceding diagnosis.

Using the prediagnostic case and noncase sera from the PLCO trial data, comparison with the U.S. Preventive Services Task Force (USPSTF) 2013 criteria risk threshold for screening showed that the combined 4MP plus PLCOm2012 model improved sensitivity in detection to 83.5% vs 71.6% (difference = 11.9%, 95% CI = 7.0%–17.2%) and specificity to 69.3% vs 56.4% (difference = 12.9%, 95% CI = 10.6%–15.2%). Similarly, comparison with the USPSTF 2021 criteria risk threshold showed improvement in sensitivity (88.4% vs 78.5%, difference = 9.9%, 95% CI = 5.3%–4.4%) and specificity (56.2% vs 49.3%, difference = 6.9%, 95% CI = 4.6%–9.4%).

Among PLCO participants with ≥10 smoking pack-years, the 4MP plus PLCOm2012 model would have identified 9.2% more lung cancer cases for annual screening and would have reduced referral by 13.7% among noncases compared with USPSTF 2021 criteria.

The investigators concluded, “A blood-based biomarker panel in combination with PLCOm2012 significantly improves lung cancer risk assessment for lung cancer screening.”

Samir M. Hanash, MD, PhD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by grants from the National Institutes of Health, National Cancer Institute, and others. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.