P1.03-04 Use Supernatant of Malignant Pleural Effusion to Identify Driver Mutants and Monitor Response to Targeted Therapy

Abstract

Malignant pleural effusion (MPE) from patients with non-small cell lung cancer (NSCLC) is useful for genetic testing due to advantages including availability, less-invasiveness, and less-heterogeneity. Generally, cell pellets of MPE are used. This study is to further address whether supernatant of MPE is a suitable source to identify key oncogenic mutants in NSCLC patients and provide evidence for clinical molecular testing. MPE samples from 12 NSCLC patients were centrifuged to obtain supernatants and cell pellets, and DNA were extracted. The DNA samples were analyzed by next generation sequencing (NGS) panels using Illumina HiSeq platform. First, MPE samples with the corresponding cancer tissues were collected from 3 NSCLC patients and analyzed with a 500-gene comprehensive cancer panel. Nine mutants were identified in both the paired MPE and cancer tissue samples. We then analyzed nine more NSCLC patient samples using an 18-gene panel to detect key oncogenic mutants; in total, 8 mutants including EGFR L858R, 19DEL, or T790M were identified in the MPE samples. For all of the 17 mutants from the 12 MPE samples, 10 mutants were observed in both the supernatants and pellets of the matched sample sets, of which more pairs (6 out of 10) had supernatants with higher abundance of mutants than the corresponding cell pellets. Importantly, 7 of the 17 mutants were detected only in the supernatants but not the pellets of the paired MPE samples. These results suggest that supernatant of MPE is a better source to detect key oncogenic mutants of NSCLC. Interestingly, 2 patients had both sensitive and resistant mutants to EGFR tyrosine kinase inhibitor (TKI) detected in supernatants of MPE; both patients had treated with EGFR TKI previously, suggesting the development of TKI resistant mutant and supporting the usage of MPE supernatants in monitoring TKI resistance. This study demonstrates that supernatant of MPE is a suitable source for identifying key oncogenic driver mutants for NSCLC and can also be used to monitor response to targeted therapy. The study provides evidence of using supernatant of MPE as an alternative for molecular testing and thus direct precise targeted therapy and surveillance of the therapy effect.