Background
This ongoing academic collaboration was initiated for providing support to set up, validate, and maintain everolimus therapeutic drug monitoring (TDM) assays and to study long-term inter- laboratory performance.
Methods
This study was based on EDTA whole blood samples collected from transplant patients treated with everolimus in a prospective clinical trial. Samples were handled under controlled conditions during collection, storage, and were shipped on dry ice to minimize freeze-thaw cycles.
For more than 1.5 years participating laboratories received a set of 3 blinded samples on a monthly basis. Among others, these samples included individual patient samples, patient sample pools to assess long-term performance and patient samples pools enriched with isolated everolimus metabolites.
Results
The results between LC-MS/MS and the everolimus Quantitative Microsphere System (QMS, Thermo Fisher) assay were comparable. The monthly inter-laboratory variability (CV%) for cross validation samples ranged from 6.5 – 23.2% (average of 14.8%) for LC-MS/MS and 4.2 – 26.4% (average of 11.1%) for laboratories using the QMS assay. A blinded long-term pool sample was sent to the laboratories for 13 months. The result was 5.31 ± 0.86 ng/mL (range 2.9–7.8 ng/mL) for the LC-MS/MS and 5.20 ± 0.54 ng/mL (range 4.0–6.8 ng/mL) for QMS laboratories.
Conclusions
Enrichment of patient sample pools with 5–25 ng/mL of purified everolimus metabolites (46-hydroxy everolimus and 39-O-desmethyl everolimus) did not affect the results of either LC-MS/MS or QMS assays.
Both LC-MS/MS and QMS assays gave similar results and showed similar performance, albeit with a trend towards higher inter-laboratory variability among laboratories using LC-MS/MS than the QMS assay.