A new stool-based test is showing promise in the noninvasive detection of colorectal cancer. The multitarget fecal immunochemical test showed higher detection rates across many different lesion and cancer types than traditional FIT in a study published in Lancet Oncology (2024;25[3]:326-337).
To support earlier and more accurate noninvasive CRC screening, researchers at the Netherlands Cancer Institute, the Erasmus MC and the Amsterdam UMC developed the mtFIT, which like a FIT evaluates hemoglobin but adds two other biomarkers: serpin family F member 2 and calprotectin.
Researchers lead by senior researcher Gerrit Meijer, MD, an investigator at the Netherlands Cancer Institute, found that the mtFIT had better positivity and detection rates than the FIT (positivity, 9.11% vs. 4.08%; detection, 2.27% vs. 1.21%, respectively). The researchers also estimated through modeling that the new test could result in a 21% reduction in CRC incidence and an 18% reduction in related mortality compared with the current Dutch national screening program using FIT.
For the study, the researchers asked individuals participating in the Dutch national FIT screening program to submit both FIT and mtFIT samples from the same bowel movement. Of the 13,187 participants, slightly more than half were male (50.3%). All individuals were between the ages of 55 and 75 years.
Detection rates were higher for mtFIT than FIT with respect to CRC (0.20%; 95% CI, 0.13%-0.29% vs. 0.17%; 95% CI, 0.11%-0.27%), advanced adenomas (1.64%; 95% CI, 1.43%-1.87% vs. 0.86%; 95% CI, 0.72%-1.04%), advanced serrated polyps (0.43%; 95% CI, 0.33%-0.56% vs. 0.17%; 95% CI, 0.11%-0.26%) and neuroendocrine tumors (0.02%; 95% CI, 0.00%-0.06% vs. 0.00%; 95% CI, 0.00%-0.04%).
Seeking Stage Shift
Current population-wide CRC screening systems, like that used in the Netherlands, use the FIT. The researchers said they hope mtFIT could bring better results for these programs. Dr. Meijer told Gastroenterology & Endoscopy News that “a screening program is effective when you see a shift in the proportion of individuals that are being diagnosed in stage III and IV to many more patients being diagnosed in stage I and II.”
He acknowledged that it will be some time before the mtFIT is available. “We seek to engage with other commercial partners,” he said, “to develop this, and the timeline for that could be somewhere around four to five years.”
Mohammad A. Al-Haddad, MD, MS, the Naga P. Chalasani Professor of Gastroenterology and Hepatology at Indiana University School of Medicine, in Indianapolis, who was not involved with the study, stressed that a test like this would work in conjunction with endoscopy. “Endoscopic management of such colonic polyps remains the most effective strategy to reduce the risk of colon cancer.”
