Pulmonary Oncology

Lung cancer is the most common fatal cancer. Pulmonary Oncology is a major focus of research at UCL Respiratory, from basic science investigation of how lung cancer develops to clinical trials.

Are robotics and AI the secrets to earlier lung cancer diagnosis?

Dr Neal Navani discusses the lung cancer screening SUMMIT, promising innovations in lung cancer diagnostics, and what they might mean for the future of lung cancer care. Cancer Research UK's Lung Cancer Centre of Excellence, UCL and University College London Hospital (UCLH) are at the forefront of lung cancer innovations, pioneering diagnostic modalities such as endobronchial ultrasound.

Concept image of lungs overlaid by a constellation pattern in red

Principal Investigators

Professor Sam Janes

Dr Joe Jacob

Dr Neal Navani

Dr Ricky Thakrar

Professor Ashley Groves

Dr Vitor Teixeira

World-leading research

Lung cancer is the leading cause of cancer-related deaths worldwide. It causes 35,000 deaths per year in the UK alone. Other cancers of the respiratory system (e.g. mesothelioma, a cancer of the pleura) are also important causes of morbidity and mortality.

Around one third of lung cancer cases arise from precancerous lesions in the airway epithelium. However, only around half of these lesions progress to incurable invasive cancer, while the rest remain stable or even disappear.

The Janes group conducts world-leading airway stem cell biology and lung cancer research to delineate the biological processes supporting airway homeostasis and to identify the earliest cellular and molecular events causing lung cancer. It also develops innovative methods of lung cancer diagnosis, staging and treatment, as well as tissue engineering strategies to replace damaged airways.

Lung tissue - red and orange in the centre, then yellow, green and blue at the fringes

Early cancer detection

We investigate the processes controlling lung cancer formation and progression and aim to develop new methods of early lung cancer detection, staging and treatment.

A primary goal of our research is to understand the biological processes that cause precancerous cells in the human airways to progress into incurable invasive lung cancer.

We have recently discovered molecular differences between lesions that progress to cancer and lesions that disappear. We are investigating how these alterations affect the properties of airway epithelial cells and their interaction with their microenvironment.

We aim to identify key genes whose malfunction promotes invasive behaviour in pre-cancerous cells, as well as the mechanisms underlying immune evasion. This work fits our clinical interest in monitoring a large cohort of patients with pre-invasive lung cancer lesions.

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Mesothelioma

Mesothelioma is a cancer of the lung lining. Current treatment options are limited. With Ultan McDermott's lab in the Wellcome Trust Sanger Institute, we have investigated whether mutations commonly seen in mesothelioma affect how the cancer would respond to different drugs.

We discovered that mesothelioma cells with mutations in BRCA associated protein-1 (BAP1) are sensitive to the anti-cancer drug TRAIL (TNF-related apoptosis-inducing ligand). Since BAP1 is the most common mutation in mesothelioma, our findings may open up a new treatment approach.

Identifying an infrared spectral biomarker of lung cancer risk

We have used infrared spectroscopy to detect changes in healthy cheek cells that indicate the presence of a distal lung cancer.

Supported by the Roy Castle Lung Foundation, we are working to identify a novel way to detect lung cancer through a cheek (buccal) swab.

We take the sample by rotating a soft brush on the inside of the cheek. The cells are prepared and placed on a slide, which is analysed using infrared light.

Promising initial results show that we can differentiate between people with cancer and without by simple, non-invasive sampling.

This has the potential to be used as an early screening tool for lung cancer to improve early diagnosis. We are currently expanding recruitment and validating our analysis.

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LuCID 2 Trial

Lungs for Living is coordinating the UCL/UCLH participation in the LuCID 2 Trial, conducted by Owlstone Medical. This is a multi-centre prospective phase II trial, investigating the diagnostic accuracy of a breath test to detect lung cancer, with a view to improving early diagnosis. The study has been recruiting since 2015.

Stem Cells

We are investigating the potential of using stem cells to deliver anti-cancer therapies. Through rational integration of fundamental, translational, and clinical studies from our team, we are taking this novel therapy from bench to bedside. Our successful pre-clinical projects funded by the Wellcome Trust, examined the use of modified stem cells to deliver the anti-cancer drug TRAIL to tumours. This led to the TACTICAL trial.

A group image of research staff and postgraduates at UCL Respiratory

Publications

Aslani S, Alluri P, Gudmundsson E ... Janes SM ... Jacob J (2024). Enhancing cancer prediction in challenging screen-detected incident lung nodules using time-series deep learning. Comput Med Imaging Graph. 2024 May 20;116: 102399. Epub ahead of print.
Cheng DO, Khaw CR, McCabe J ... Janes SM, Jacob J (2024). Predicting histopathological features of aggressiveness in lung cancer using CT radiomics: a systematic review. Clin Radiol. 2024 May 17: S0009-9260(24)00248-4.
Giddings R, Joseph A, Callender T, Janes SM ... Navani N (2024). Factors influencing clinician and patient interaction with machine learning-based risk prediction models: a systematic review. Lancet Digit Health. 2024 Feb;6(2): e131-e144.
Black GB, Janes SM, et al (2024). The Role of Smoking Status in Making Risk-Informed Diagnostic Decisions in the Lung Cancer Pathway: A Qualitative Study of Health Care Professionals and Patients. Med Decis Making. 2024 Feb;44(2): 152-162.
Callender T, Imrie F ... Navani N, van der Schaar M, Janes SM (2024). Assessing eligibility for lung cancer screening using parsimonious ensemble machine learning models: development and validation study. PLoS Med. 2023 Oct 3;20(10): e1004287.

Creamer AW, Horst C, Dickson JL ... Janes SM; SUMMIT Consortium (2024). Stage at Diagnosis Following Delay to Interval Scans for Indeterminate Nodules in Lung Cancer Screening: An Observational Study Examining the Outcomes of CHEST Expert Panel Recommendations. Chest. 2024 Apr;165(4): 1020-1024.
Hynds RE, Huebner A, Pearce DR, Hill MS ... Janes SM, et al (2024). Representation of genomic intratumor heterogeneity in multi-region non-small cell lung cancer patient-derived xenograft models. Nat Commun. 2024 May 31;15(1): 4653.
Succony L, Gómez-López S, Pennycuick A, Alhendi ASN ... Janes SM (2022). Lrig1 expression identifies airway basal cells with high proliferative capacity and restricts lung squamous cell carcinoma growth. Eur Respir J. 2022 Mar 31;59(3): 2000816.
Pennycuick A, Teixeira VH, AbdulJabbar K, Raza SEA ... Thakrar RM ... Janes SM (2020). Immune Surveillance in Clinical Regression of Preinvasive Squamous Cell Lung Cancer. Cancer Discov. 2020 Oct;10(10): 1489-1499.
Yoshida K, Gowers KHC, Lee-Six H ... Thakrar RM ... Janes SM, et al (2020). Tobacco smoking and somatic mutations in human bronchial epithelium. Nature. 2020 Feb; 578(7794): 266-272.

Funding and Partners

Can collaborative partnerships with industry drive vital improvements in lung cancer outcomes?

Technology can transform the way we work by optimising patient pathways to provide faster access to diagnostics and treatment. Vicky Heaton and Dr Neal Navani discuss how industry partnerships can achieve faster diagnosis and treatment in lung cancer care. A new lung cancer pathway optimisation initiative, PATHFINDER, has the potential to benefit patients, healthcare professionals and the NHS.

Fluoroscopic view of cancer in the lungs