Deep generative AI models analyzing circulating orphan non-coding RNAs enable accurate detection of early-stage non-small cell lung cancer

Liquid biopsies have the potential to revolutionize cancer care through non-invasive early detection of tumors, when the disease can be more effectively managed and cured. Developing a robust liquid biopsy test requires collecting high-dimensional data from a large number of blood samples across heterogeneous groups of patients. We propose that the generative capability of variational auto-encoders enables learning a robust and generalizable signature of blood-based biomarkers that capture true biological signals while removing spurious confounders (e.g., library size, zero-inflation, and batch effects). In this study, we analyzed orphan non-coding RNAs (oncRNAs) from serum samples of 1,050 individuals diagnosed with non-small cell lung cancer (NSCLC) at various stages, as well as sex-, age-, and BMI-matched controls to evaluate the potential use of deep generative models. We demonstrated that our multi-task generative AI model, Orion, surpassed commonly used methods in both overall performance and generalizability to held-out datasets. Orion achieved an overall sensitivity of 92% (95% CI: 85%–97%) at 90% specificity for cancer detection across all stages, outperforming the sensitivity of other methods such as support vector machine (SVM) classifier, ElasticNet, or XGBoost on held-out validation datasets by more than ∼30%. ### Competing Interest Statement The authors are either employees, shareholders, or stock option holders of Exai Bio, Inc. ### Funding Statement This study was funded by Exai Bio Inc. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of MT Group (Los Angeles, CA) gave ethical approval for this work. Ethics committee/IRB of Indivumed Services (Frederick, MD) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors