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Use of discard pleural fluid in molecular research

Nature Reviews Clinical Oncology volume 9, page 64 (2012)Cite this article

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The October 2011 issue of Nature Reviews Clinical Oncology included a Perspectives article by Olson et al. (The ethical use of mandatory research biopsies. Nat. Rev. Clin. Oncol. 8, 620–625)1 on the ethical dilemma faced by researchers and institutional review boards (IRBs) when a molecular research study requires obtaining multiple tissue samples from the internal organs of patients with solid tumors during the course of treatment. Although such biopsy material is of potential use for the analysis of molecular changes in tumor cells following treatment, IRBs are reluctant to allow the inclusion of serial biopsies in human research protocols, as serial biopsies of solid tumors provide no direct benefit to the patient and might cause anxiety, discomfort, bleeding or other serious complications (F. Grannis, personal communication). However, there is a simple, safe, ethical and inexpensive alternative that can resolve the clinical and ethical objections to obtaining serial samples of cancer cells during treatment.

Malignant pleural effusions are found in as many as 100,000 patients with cancer—most commonly in those with lung and breast cancers—every year in the US.2 To provide relief from shortness of breath caused by pleural effusions, patients are treated by the placement of tunneled pleural catheters.3,4 Following the placement of a catheter, the patient's caregivers drain the pleural effusions at frequent intervals in outpatient settings and discard the pleural fluid. The discarded fluid is of potential use in molecular research as malignant plural effusions are known to be cytologically positive for cancer cells in about 50% of patients.5,6 On several occasions, cancer cell lines have been developed from these effusions.7,8 The opportunity to serially harvest cells from the discarded fluid during the course of treatment offers the possibility of analyzing the molecular changes in patients' cancer cells.

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References

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  1. City of Hope National Medical Center, 1500 East Duarte Road, Duarte, 91010, CA, USA

    Frederic W. Grannis Jr

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  1. Frederic W. Grannis Jr
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The author declares that he has been using the PleurX® Catheter System (CareFusion Corporation, San Diego, California, USA) in palliative care of patients for many years and that he received remuneration from CareFusion for a lecture.

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Grannis, F. Use of discard pleural fluid in molecular research. Nat Rev Clin Oncol 9, 64 (2012). https://doi.org/10.1038/nrclinonc.2011.114-c1

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