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Mol Oncol ; 13(12): 2633-2645, 2019 12.
Article in English | MEDLINE | ID: mdl-31529604

ABSTRACT

Many advanced cases of cancer show central nervous system, pleural, or peritoneal involvement. In this study, we prospectively analyzed if cerebrospinal fluid (CSF), pleural effusion (PE), and/or ascites (ASC) can be used to detect driver mutations and guide treatment decisions. We collected 42 CSF, PE, and ASC samples from advanced non-small-cell lung cancer and melanoma patients. Cell-free DNA (cfDNA) was purified and driver mutations analyzed and quantified by PNA-Q-PCR or next-generation sequencing. All 42 fluid samples were evaluable; clinically relevant mutations were detected in 41 (97.6%). Twenty-three fluids had paired blood samples, 22 were mutation positive in fluid but only 14 in blood, and the abundance of the mutant alleles was significantly higher in fluids. Of the 34 fluids obtained at progression to different therapies, EGFR resistance mutations were detected in nine and ALK acquired mutations in two. The results of testing of CSF, PE, and ASC were used to guide treatment decisions, such as initiation of osimertinib treatment or selection of specific ALK tyrosine-kinase inhibitors. In conclusion, fluids close to metastatic sites are superior to blood for the detection of relevant mutations and can offer valuable clinical information, particularly in patients progressing to targeted therapies.


Subject(s)
Acrylamides/administration & dosage , Anaplastic Lymphoma Kinase , Aniline Compounds/administration & dosage , Ascitic Fluid , Lung Neoplasms , Mutation , Neoplasm Proteins , Pleural Effusion, Malignant , Aged , Anaplastic Lymphoma Kinase/genetics , Anaplastic Lymphoma Kinase/metabolism , Ascitic Fluid/metabolism , Ascitic Fluid/pathology , Carcinoma, Non-Small-Cell Lung/cerebrospinal fluid , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/pathology , ErbB Receptors/cerebrospinal fluid , ErbB Receptors/genetics , Female , HT29 Cells , Humans , Lung Neoplasms/cerebrospinal fluid , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Proteins/cerebrospinal fluid , Neoplasm Proteins/genetics , Pleural Effusion, Malignant/cerebrospinal fluid , Pleural Effusion, Malignant/drug therapy , Pleural Effusion, Malignant/genetics , Prospective Studies
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