Blood Test for Breast Cancer Associated Auto Antibodies
Since the mutations of a normal cell that lead to a malignancy, involves changes in the
structure and function of the cells, it could be assumed that the immune system has
recognized some of these changes as antigenic determinates that should be responded against.
For many years, investigators tried to distinguish between cancer patients and healthy
population by the difference in specific autoantibodies level. In the healthy population, a
baseline of the amount of autoantibodies was determined, and the patient population had to
have a statistically significant higher level of autoantibodies. Many examples of this
method can be found in the scientific literature [example references - Naora et.al. (2001);
mintz et. Al. (2003); Korneeva et. Al (2000)]. The presence of autoantibodies in all
population in different levels made it very difficult to find these specifically
discriminating antibodies. To date, no specific autoantibody is distinguishing solely
between healthy and cancer patients (as opposed to autoimmune diseases, where specific
autoantibodies can be found in very high levels in patients only).
Our work assumes that specific Autoantibodies expression level should be altered in cancer,
and thus these differences can indicate the presence / absence of cancer.
In this experiment protocol, we are checking for differences in expression levels of
specific autoantibodies of suspected breast pathology.
Future CAAA Test Intend of use - Identification of specific breast CAAAs, could provide the
clinician with additional immunological and antigenic information regarding the patient's
condition or medical status.
Test major steps and components - The CAAA test is comprised of a blood collection and
processing step followed by detection of specific auto antibodies with an ELISA based assay
and a mathematical processing, with a subsequent classification of the results as "positive"
or "negative" for breast cancer.
The study population includes all women that are scheduled for a pathological or cytological
confirmation either by any kind of biopsy or cytology, prior to any anti-cancer treatment.
The clinical suspicion includes one of the following: positive mammography/US/MRI, and
suspected physical check. Final verification ("true positive" or "true negative") will be
done in relation to pathology/cytology only.
The "true positive" group consists of all sequential patients that satisfy inclusion
criteria and have positive biopsy results. The "true negative" group consists of sequential
patients that satisfy inclusion criteria and have negative biopsy results.
Written informed consent must be obtained prior to obtaining a blood sample from the
This study will be based on multi-centers participation. The minimum number of sites for the
study is 2.
All sites will be within Hospitals either in the surgery department or the relevant specific
unit which is responsible for providing care for the BC patients.
The same protocol and the same monitoring routines will be applied to all sites. All CRF
data will be submitted electronically through a dedicated and secured internet site, all
changes will be tracked. When performing the CAAA tests, the Lab/ Sponsor team will have no
information regarding the nature of the sample. This pathological information will be
provided for statistical evaluation in parallel to the CAAA test.
Overall Description - The current study is a single blind case-control validation study,
involving all consecutive breast cancer subjects having positive biopsy results (true
positive) and equal number of patients with negative biopsy results (true negative). The
purpose of the study is to evaluate the effectiveness of the CAAA test.
The effectiveness of the study is defined as the specificity of the CAAA test for a pre
defined sensitivity of 95%.
The study will evaluate the sensitivity of CAAA test to show that it is not below the
declared level of 95%.
The study will evaluate the specificity of CAAA test in the new study population.
According to known results of PPV of mammography in various populations we assume that the
study population will include about 30% of true positive cancer cases.
As of today, large proportion of the suspected subjects was only diagnosed by final
pathology of the biopsy. In this study, the true positive and true negative cases (as
verified by biopsy) will be compared to the CAAA test results.
In the hospital:
First, an identified study subject has to sign an informed consent form, and her Eligibility
Form filled ,both should be bar-coded.
Subjects' clinical information acquired from the patient's medical file, including age,
medical history and results of tests done leading to the diagnostic evaluation of breast
cancer will be recorded on the appropriate, bar-coded, pre-study case report forms. The
reports will be electronic via a dedicated and secured internet site, any changes in the
database will be recorded and will be traceable. A hard copy of the records will be kept in
the department. The study is anonymous and the Department will keep the name of the patient
without reveling it to investigators and to the study sponsor.
The doctor/ nurse/ phlebotomist will collect a heparin vacuum tube (about 8ml), label
(bar-code) them. The tube with the blood will be packaged in a double sealed container.
The blood will be transported at room temperature (18-25°C), according to the relevant
regulations, to the laboratory. Transportation time will be not more than 6 hours.
The blood handling laboratory will collect serum according to the protocol, and the serum
will be kept frozen at -80, in properly labeled aliquots. The frozen samples will be sent to
the diagnostic laboratory for antibody tests.
In the diagnostic laboratory ELISA based tests for the detection of Auto Antibodies relative
expression ratios, will be conducted on each sample according to the lab protocol . The
samples will be tested for antibodies levels for the antigens that have been identified on a
previous training set. All the data will be permanently recorded directly into a dedicated
computer. For each sample all antibody results will be put into the coded patient file. A
mathematical algorithm will determine if the sample is positive or negative.
At the Hospital, post biopsy:
2-3 weeks after the biopsy, the CRO will collect from the patient's file the results from
the pathology lab and any other relevant information as to the nature of the suspected mass.
These results will be recorded on the dedicated and secured internet site and a printed
bar-coded CRF will be kept in the Department .
The hospital will preserve slices from the suspected masses (either from biopsy or surgery)
for future immuno-histochemical or other studies to be conducted by the sponsor.
The final pathology will be compared with the CAAA test results. The results will be
analyzed by a statistician with expertise in cancer population studies.
The patients included in this study are undergoing blood test, and only risks are those
involving in blood collection. As treatment is not affected by the results, no risks are
subjected to the patients participating in the study.
As the study is being conducted with no link to the individual patient, there is no
immediate benefit derived from the additional tests run on the blood sample. Future benefit
may be derived from the development of the assay.
The current study is a blind prospective validation study, involving all consecutive
suspected breast pathology subjects being scheduled for biopsy during the study duration.
The purpose of the study is to assess the sensitivity and specificity of the CAAA test for
detection breast cancer in women scheduled for biopsy.
Subjects will be screened for potential participation in the study, according to the
inclusion and exclusion criteria.
The data will include parameters of the clinical and pathological state of the subjects and
results of CAAA ELISA.
There are two goals of the study.
1. To test that the sensitivity of CAAA is not below the pre-defined level.
2. To evaluate the specificity of CAAA test. Statistical Hypothesis The main condition
determining the sample size is to validate that the sensitivity of the test is not
lower than the predefined level. The classification rule was established in such a way
that the sensitivity in the training set was 100%. We assume that the real sensitivity
is not lower that 99%.
Null Hypothesis: The sensitivity of the test is not higher than 95%. Alternative hypothesis:
The sensitivity of the test is not less than 99%. Data Management A database management
system shall be designed and maintained, including screen preparation, and edit check
programming. Pre-entry and post-entry quality control of the clinical data shall be
performed at each data entry center. All ELISA test results will be uploaded to the database
via an internet based interface, and will be locked against further changes. In order to
change ELISA test results, unlocking of the database requires consent from the local CRO,
the sponsor and the site physician. Unlocking will be done only by the webmaster, and will
be recorder in the tracing system component, and in a hard copy held both by the sponsor and
the CRO in the site.
Observational Model: Cohort, Time Perspective: Prospective
Tanir Allweis, MD
Kaplan Medical Center
Israel: Ethics Commission