Introduction: We compared the secretome of metastatic (non-small cell lung cancer (NSCLC)) and primary (mesothelioma) malignant pleural effusions, benign effusions and the published plasma profile of patients receiving chimeric antigen receptor T cells (CAR-T), to determine factors unique to neoplasia in pleural effusion (PE) and those accompanying an efficacious peripheral anti-tumor immune response.
Materials and Methods: Cryopreserved cell-free PE fluid from 101 NSCLC patients, 8 mesothelioma and 13 with benign PE was assayed for a panel of 40 cytokines/chemokines using the Luminex system.
Results: Profiles of benign and malignant PE were dominated by high concentrations of sIL-6R?, CCL2/MCP1, CXCL10/IP10, IL-6, TGF?1, CCL22/MDC, CXCL8/IL-8 and IL-10. Malignant PE contained significantly higher (p < 0.01, Bonferroni-corrected) concentrations of MIP1?, CCL22/MDC, CX3CL1/fractalkine, IFN?2, IFN?, VEGF, IL-1? and FGF2. When grouped by function, mesothelioma PE had lower effector cytokines than NSCLC PE. Comparing NSCLC PE and published plasma levels of CAR-T recipients, both were dominated by sIL-6R? and IL-6 but NSCLC PE had more VEGF, FGF2 and TNF?, and less IL-2, IL-4, IL-13, IL-15, MIP1? and IFN?.
Conclusions: An immunosuppressive, wound-healing environment characterizes both benign and malignant PE. A dampened effector response (IFN?2, IFN?, MIP1?, TNF? and TNF?) was detected in NSCLC PE, but not mesothelioma or benign PE. The data indicate that immune effectors are present in NSCLC PE and suggest that the IL-6/sIL-6R? axis is a central driver of the immunosuppressive, tumor-supportive pleural environment. A combination localized antibody-based immunotherapy with or without cellular therapy may be justified in this uniformly fatal condition.
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