Early Multi-Omic Cancer Assessment: eMOCA

Lung cancer is a leading cause of cancer related mortality, claiming an estimated 1.8 million lives in 2020.

In the EU, lung cancer accounts for 12% of all new cancer diagnoses and 20% of all cancer deaths, Although helpful in identifying early-stage lung cancer, screening programs frequently lead to false-positives and overdiagnosis.

This is exacerbated by a lack of clinically useful biomarkers to accurately differentiate between lung cancer and indeterminate nodules found in the lung.

Recent studies on lung adenocarcinoma (LUAD) suggest that microbial and host genomic signatures could be leveraged to develop useful biomarkers in early-stage disease.

However, these studies are based on systemic signatures identified, using metagenomics, in plasma rather than at the site of the disease, the lung. Very little research has been done on lung squamous cell cancer (LUSC).

It is likely that both microbial and host signatures in the lungs of patients with LUSC, a more centrally located cancer, will be more specific and have stronger predictive power as biomarkers. Sampling of the lung is difficult however and involves invasive procedures such as bronchoscopy.

Exhaled breath condensate (EBC) is a novel non-invasive method of collecting lower airways samples, which I will use to evaluate the lung micro-environment in LUSC.

Furthermore, microbial RNA sequencing (metatranscriptome) provides broader and more detailed insight into the active function of microbes in different environments, while metabolomics provides further insight into the by-products of microbial metabolism.

Applying this unbiased omic approach (metagenome, metatranscriptome, metabolome & transcriptome) to multiple sample types (blood, sputum, EBC & bronchoscopy samples) will allow identification of novel microbial biomarkers capable of distinguishing between LUSC and non-malignant nodules, and predicting LUSC progression and may help guide the development of new targeted treatment approaches in LUSC.