Oncological treatment of patients with disseminated non-small cell lung cancer (NSCLC) is depending on the status of programmed death-ligand 1 (PD-L1), anaplastic lymphoma kinase (ALK) and epidermal growth factor receptor (EGFR), so called oncodrivers. These can be measured in pleural fluid, but the prevalence is uncertain. In a prospective study, the research team aim to measure PD-L1, ALK and EGFR in patients with pleural fluid cytology positive for NSCLC to report the prevalence. Also, the study will investigate if the chance of obtaining oncodriver status is depending on the volume analysed and how the lack of oncodrivers influence the following work-up.
The study is a prospective, non-randomized, cohort study of patients with pleural effusion. Participants will be recruited from patients referred to the Pleura Clinic or admitted at the ward at the Department of Respiratory Medicine, Næstved Hospital, Næstved or at the Department of Respiratory Medicine, Zealand University Hospital, Roskilde, which is the two regional centres for workup of pleural effusions. Patients will be referred from either general practice or other hospital departments. Pleural fluids with cytology positive for NSCLC will be tested for oncodrivers (for squamous cell carcinomas (SCC): PD-L1, for adenocarcinomas (AC): PD-L1, ALK and EGFR). Follow-up will be 8 weeks after inclusion.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
100
PD-L1 test will be performed on cell-blocks using PD-L1 antibodies 22C3 and staining platform Dako Omnis (Agilent, Glostrup -Denmark). ALK test will be performed on cell-blocks using staining platform Dako Omnis (Agilent, Glostrup- Denmark) and ALK antibodies "Origene" clone: OT1A4. Sample quality is assessed as for PD-L1. EGFR mutation analysis will be performed as follows: after tumor content evaluation of hematoxylin and eosin stained slides, relevant regions are macrodissected and subjected to a standard genomic DNA extraction procedure using the GeneRead DNA FFPE Kit (Qiagen). Samples will be analysed using the GeneRead QIAact Actionable Insights Tumor Panel (Qiagen)
Næstved Sygehus, department of pulmonary medicine
Næstved, Region Sjælland, Denmark
RECRUITINGPrevalence of oncodriver status
Prevalence of oncodriver status (for squamous cell carcinomas (SCC): PD-L1, for adenocarcinomas (AC): PD-L1, ALK and EGFR) in pleural fluid in patients with cytology positive for pulmonary NSCLC
Time frame: assessed at 8 weeks follow-up
Proportion of adequate and inadequate pleural fluid specimens
Time frame: assessed at 8-week follow-up
Amounts of pleural fluid sent for analysis
Meassured in mL.
Time frame: assessed at 8-week follow-up
Correlation between amounts of pleural fluid sent to the pathologist and the chance of obtaining oncodriver status
Time frame: assessed at 8-week follow-up
Number and type of additional diagnostic interventions including additional thoracentesis and cytological or histological biopsies
Time frame: assessed at 8-week follow-up
Prevalence of oncodriver status in additional diagnostic interventions
Time frame: assessed at 8-week follow-up
- Correlation between oncodriver status obtained in pleural fluid specimens and cytological or histological biopsies
Time frame: assessed at 8-week follow-up
- Proportion of work-ups where the lack of obtained oncodriver status in pleural fluid specimens leads to additional diagnostic interventions including additional thoracentesis and cytological or histological biopsies
Time frame: assessed at 8-week follow-up
- Proportion of work-ups where full oncodriver-status was obtained at the second thoracentesis
Time frame: assessed at 8-week follow-up
- Proportion of patients with pleural fluid cytology negative of NSCLC, who is diagnosed with NSCLC.
Time frame: assessed at 8-week follow-up
Patient assessed pain during thoracentesis
assessed by a questionnaire containing a VAS (Visual Analogue Scale, scale 0-10, 0 being no pain, 10 being the worse pain)
Time frame: at day 1, 2 minutes after thoracentesis
Proportion of patients experiencing pneumothorax
Time frame: assessed at day 1, 10 minutes after thoracentesis and 8-week follow-up by evaluating the patient file
Proportion of patients experiencing bleeding
Time frame: assessed at day 1, 10 minutes after thoracentesis and 8-week follow-up
Proportion of complications leading to admission
assessed by evaluating the patient file
Time frame: assessed at 8-week follow-up
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