Q&A: Multitarget FIT bests regular FIT in adenoma detection
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Multitarget fecal immunochemical testing yielded better diagnostic accuracy in the detection of advanced adenomas compared with basic FIT, according to research published in Annals of Internal Medicine.
“Early detection is the most realistic approach for reducing death from colorectal cancer and programmatic stool-based screening, using FIT, has been very successful,” Meike de Wit, PhD, Netherlands Cancer Institute, told Healio. “However, the sensitivity of FIT for relevant precursor lesions, advanced adenomas, is not that high and improving that sensitivity for advanced adenomas is critical to improve the early detection of CRC.”
To develop a multitarget FIT (mtFIT) with increased diagnostic performance, researchers developed antibody-based assays and performed classification and regression tree (CART) analysis on biomarker concentrations from 1,284 people in a screening and referral population. According to CART analysis, a combination of hemoglobin, calprotectin and serpin family F member 2 was optimal for the detection of advanced neoplasia. Cross-validated sensitivity was 42.9% (95% CI, 36.2-49.9) for mtFIT vs. 37.7% (95% CI, 30.7-44.2) for FIT. Further cross-validated sensitivity for CRC was 78.7% (95% CI, 64.3-89.3) vs. 80.9% (95% CI, 66.7-90.9), respectively.
Healio Gastroenterology spoke with de Wit about how key study findings will inform CRC screening going forward and what future research is still needed.
Healio Gastroenterology: What were the key study findings?
Meike de Wit: We found that a combination of three proteins (biomarkers), which we named the mtFIT, had significantly higher sensitivity than FIT for advanced neoplasia (ie, CRC and advanced precursor lesions) with equal specificity as FIT. The improvement was seen in the advanced adenomas, for which sensitivity was increased by 35%, while sensitivity for CRC did not change. Health technology modelling showed that when performed biennially and compared with traditional biennial FIT, mtFIT would reduce CRC incidence and mortality by 12% and 8%, respectively.
Healio: What is the most important take-home message?
de Wit: Early detection of CRC can save many lives and the mtFIT is cost-effective approach to substantially improve upon the widely used FIT by detecting more advanced adenomas. This autumn we will start a prospective screening trial among 13,000 participants of the Dutch national population-based screening program.
Healio: How do these results inform CRC screening going forward?
de Wit: We are currently preparing a prospective clinical trial (n = 13,000) in the context of the Dutch national CRC screening program in which the new test will be compared head-to-head with the current FIT test. We hope to collect final evidence that the mtFIT test will result in the detection of more advanced adenomas and CRC. In that case, the mtFIT would have the potential to improve CRC screening in the future by reducing even more CRC incidence and mortality.
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Klaver WD, et al. Ann Intern Med. 2021;doi:10.7326/M20-8270.
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