Employing “electronic nose” (eNose) technology early during treatment can accurately identify patients with advanced non-small cell lung cancer (NSCLC) who respond to immunotherapy, according to research published in Lung Cancer.

The technology can allow for noninvasive, low-cost identification of responders early on, which could save patients from ineffective treatment, “thereby preventing undesirable events and reducing unnecessary costs,” according to researchers.

The researchers explained that eNoses recognize gas mixtures from volatile organic compounds resulting from metabolic changes in the body and can be used for probabilistic assessment of disease states.

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In a prospective, observational study, the researchers sought to determine the accuracy of exhaled breath patterns for differentiating true responders from non-responders early during anti-PD-1 therapy.

The study enrolled 94 patients receiving nivolumab or pembrolizumab. The patients were randomly assigned 2:1 to a training cohort (62 patients) or a validation cohort (32 patients).

Exhaled breath measurements were performed using a commercial eNose (SpiroNose). Baseline measurements were done a median of 2 weeks (range, 0-6 weeks) before treatment. Follow-up measurements were done a median of 6 weeks (range, 4-8 weeks) after treatment began.

The researchers created 2 models, 1 based on baseline measurements with eNose (baseline model) and 1 that included eNose measurements at baseline and at the 6-week time point (on-treatment model).

In the training cohort, the baseline model had a specificity of 54% when a sensitivity of 100% was required, and the area under the curve (AUC) was 0.81 (CI, 0.71-0.92). The on-treatment model had a specificity of 73% at 100% sensitivity and an AUC of 0.95 (CI, 0.89-1.00).

In the validation cohort, the baseline model had a specificity of 68% at 100% sensitivity and an AUC of 0.89 (CI, 0.76-1.00). The on-treatment model had a specificity of 84% at 100% sensitivity and an AUC of 0.97 (CI, 0.91-1.00).

“This prospective, observational study shows that SpiroNose exhaled breath analysis can be used to identify advanced NSCLC patients with an objective response to anti-PD-1 therapy more accurately at [an] early stage of treatment when compared to baseline as part of routine assessment during early treatment monitoring in daily clinical practice,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Buma AIG, Muller M, de Vries R, et al. eNose analysis for early immunotherapy response monitoring in non-small cell lung cancer. Lung Cancer. 2021;160:36-43. doi:10.1016/j.lungcan.2021.07.017