Humberto Choi, MD: Screening & Treatment Overlap in Lung Cancer, COPD

In an interview with MD Magazine® while at the CHEST 2019 Annual Meeting in New Orleans, Humberto Choi, MD, a pulmonologist with the Cleveland Clinic, detailed his team’s research into improved lung cancer screening methods, as well as an effort to consider benefit of inhaled corticosteroid therapy for the treatment of inflammation in lung cancer.

MD Mag: What are the current screening methods for lung cancer?

Choi: One of the studies I have highlighted but not discussed further is about a screening. So right now, the screening that is recommended is with a low-dose CT scan in a high-risk group. And this is based on the National Lung Screening trial, just based on age and smoking history. And those are patients that we will screen with a low-dose CT scan.

So now we're just learning more about that, and how to become more efficient with that process, because hundreds of thousands of people are being screened every day. So it's a huge burden on the pulmonologist and radiologists to find all those small nodules. They can be just in a few millimeter range.

So now we are using more and more artificial intelligence—machine learning techniques. And one of the studies that I'll highlight is an end-to-end algorithm, like an algorithm that used deep learning techniques for detection, but also for diagnosis. So just by providing the images, that algorithm was able to categorize nodules that were malignant with a very high accuracy.

So I think the process is the same. What’s in command is a low-dose CT scan in a high-risk group. But we are learning how to perfect this process, how to be more efficient and create less burden for the clinician and for the radiologists. So I think that we're going to hear more and more about how we can apply artificial intelligence into lung cancer screening.

MD Mag: Is there potential for similar innovation in COPD screening?

Choi: COPD is I think more complex, because we just need to add the clinical information, the histometric information and imaging. And I think the imaging in the future will be able to help.

Right now, screening for COPD is not recommended—but for example, in lung cancer screening, emphysema is one of the most common incidental findings. And I think we are learning what to do with that information. And this is one of the things that actually I'm studying myself: what is the clinical significance of the emphysema that we find in screening.

But it's not something that's recommended now, and I'm not aware of any other newer tools to first screening of COPD.

MD Mag: How could inhaled corticosteroids benefit lung cancer care?

Choi: One is a common medication that is prescribed. The idea is that steroids reduce inflammation in a nonspecific way. And we know that inflammation itself is part of the pathogenesis of lung cancer.

So that kind of supports the idea, that maybe reducing the inflammation may reduce the risk of lung cancer. And because the risk factor is the same for COPD in lung cancer,maybe we'll find out a way to prevent lung cancer just by using the same medications that we use for COPD.

I don't think that conclusion from this study is ready for primetime. I don't think we’re ready to drink that Kool-Aid yet. But I think it's interesting. I think that idea is asking for a large perspective trial for us test that.