Treatment Of Malignant Pleural Effusion Research Articles

Enhancing Intrapleural Hyperthermic Chemotherapy for Lung Cancer: Insights from 3D and PDX Models

Background/Objectives: Malignant pleural effusion (MPE) in lung cancer indicates systemically disseminated advanced lung cancer and is associated with poor survival. Intrapleural hyperthermic chemotherapy (IPHC) is a promising treatment for MPE; however, its biological basis is not fully understood. IPHC can enhance anticancer drug efficacy, particularly in drug-resistant cancers. This study investigated the effects of hyperthermia on cisplatin cytotoxicity in lung cancer cell lines, patient-derived tumor cells, and a patient-derived xenograft (PDX) model. Methods: Lung cancer cell lines (A549 and H2170) and patient-derived tumor cells were cultured in 2D/3D systems and treated with cisplatin under varying temperatures (37 °C, 43 °C, and 45 °C) and exposure times (5, 15, and 30 min). Antiproliferative effects were evaluated using LDH and CCK-8 assays. Optimal conditions identified in cell culture experiments were validated using a PDX model; tumor growth inhibition, delay, and protein expression were analyzed post-treatment. Results: Hyperthermia significantly enhanced the antitumor efficacy of cisplatin at 43 °C and 45 °C, with comparable effects under 15 and 30 min exposure. In the PDX model, IPHC showed increased tumor inhibition and necrosis and delayed tumor regrowth, particularly at higher cisplatin doses. Protein expression analysis revealed that hyperthermia decreased EGFR expression and increased levels of apoptosis-related proteins, including cleaved PARP and caspase-3. Conclusions: IPHC with cisplatin demonstrated enhanced antitumor efficacy in vitro models, particularly in drug-resistant lung cancer, indicating its potential as a valuable adjunct to existing treatment regimens for lung cancer and for improving patient outcomes in advanced lung cancer with MPE or pleural metastasis.

Lymph nodes rather than pleural metabolic activity in 18F-FDG PET/CT correlates with malignant pleural effusion recurrence in advanced non-small cell lung cancer.

Frequently recurrent malignant pleural effusion (MPE) significantly hampers the life quality of advanced non-small cell lung cancer (NSCLC) patients. We aimed to explore the effects of progression patterns and local intervention on MPE recurrence and apply fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to establish a predictive model for MPE recurrence in NSCLC. We retrospectively recruited two cohorts of patients including treatment-naïve NSCLC diagnosed with MPE at the onset and receiving PET/CT scanning, as well as those with MPE and undergoing first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment. Pleural maximum standardized uptake value (SUVmax), metabolic tumor burden (MTV), total lesion glycolysis (TLG), and uptake patterns as well as SUVmax of lymph nodes (LN) were extracted. The primary outcome was MPE recurrence defined as re-accumulation of cytologically proven ipsilateral MPE. Step-wise multivariate Cox regression was used to identify candidate variables. Cox regression analysis and random survival forest were applied to establish models. A total of 148 treatment-naïve patients with EGFR-TKI treatment and MPE were recruited during the median follow-up period of 683 days, with 69 (46.6%) and 35 (23.6%) witnessing MPE recurrence at least once and twice. Intrapleural perfusion therapy at first recurrence was a protective factor for the second MPE recurrence (P=0.006), while intrapleural perfusion therapy at baseline could not benefit the first MPE recurrence (P=0.14). Conversely, prior systemic progression indicative of the change of systemic treatment was a protective factor for time to the first MPE recurrence (P<0.001); instead, the change of systemic treatment at the first MPE recurrence was not associated with second MPE recurrence (P=0.53). In another cohort with treatment-naïve NSCLC patients with MPE and PET/CT scanning, 103 patients regardless of the actionable mutation status were recruited during the median follow-up period of 304 days. Multivariate analysis suggested that the LN SUVmax >4.50 g/mL [hazard ratio (HR), 2.54; P=0.01], female gender (HR, 0.40; P=0.01), bone metastases (HR, 3.16; P=0.001), and systemic treatment (targeted therapy vs. chemotherapy: HR, 0.32; P=0.002; immunotherapy therapy vs. chemotherapy: HR, 0.99; P=0.97) could collectively indicate MPE recurrence with an optimal 300-day area under the curve (AUC) of 0.83. For patients with actionable mutation, LN SUVmax >4.50 g/mL (P=0.02) could forecast MPE recurrence independently. In summary, LN rather than pleural metabolic activity or uptake patterns could predict MPE recurrence for patients with or without targeted therapy. We should re-consider the application of intrapleural perfusion treatment for first-onset MPE and prompt it more at the moment of recurrent MPE. Promisingly, we could probably apply the non-invasive tool to identify the risk factors for MPE recurrence.

Comparison of five scores to predict mortality in malignant pleural effusion.

Malignant pleural effusion (MPE) is a complication of malignancy. Treatment of MPE is based on predicted outcome. The aim of this study was to compare the performance characteristics of LENT, PROMISE, RECLS, AL and pNLR scores for prediction of mortality in lung cancer patients who have MPE. Patients who were diagnosed with MPE that was associated with underlying lung cancer between January 2010 and December 2019 were included and analyzed retrospectively in a single center. Outcomes considered were 30-day, 6 months, and 1-year mortality. A total of 180 patients were examined. For 30-day mortality, the areas under the ROC curves (AUC) (95% CI) were: LENT 0.83 (0.76-0.87), RECLS 0.71 (0.63-0.77), and PROMISE 0.70 (0.17-0.38). For 6-month and 1-year mortality the order of these AUCs was similar. Cox regression showed that none of the scores were significantly associated with 30-day mortality, but LENT and RECLS were significantly associated with 6-month and 1-year mortality. Comparison of - 2log likelihood ratios showed that LENT score was more, strongly associated with 6-month mortality than PROMISE (p = 0.001) or RECLS (p = 0.02). LENT score was also more strongly associated with 1-year mortality than PROMISE (p = 0.001) but there was no difference between LENT and RECLS score (p = 0.64). We observed that the LENT score was more predictive than the other scores in mortality in patients who have lung cancer and MPE. The LENT and RECLS scores have similar performance characteristics for prediction of 1-year mortality in these patients.

1371P An anti-EpCAM x CD3 bispecific antibody, M701, for the treatment of malignant pleural effusion in NSCLC patients: Intermediate results of a prospective multicenter phase Ib trial

1371P An anti-EpCAM x CD3 bispecific antibody, M701, for the treatment of malignant pleural effusion in NSCLC patients: Intermediate results of a prospective multicenter phase Ib trial

Investigation on the efficiency of lentinan for injection combining cisplatin on treating malignant pleural effusion based on systematic review and meta-analysis.

Malignant pleural effusion (MPE) is a frequently observed complication in advanced malignant tumors. Clinical studies have shown that lentinan for injection (LNT) is beneficial for improving patients' quality of life and prolonging their survival. The purpose of this meta-analysis is to evaluate the efficacy and safety of LNT combining cisplatin in the treatment of MPE. Randomized controlled trials (RCTs) of LNT combining cisplatin in the treatment of MPE were searched in 6 literature databases from the establishment time of each database by 2 researchers. According to the inclusion criteria, 2 researchers independently screened studies, assessed the risk of bias and conducted subgroup analyses for different outcome indicators according to the specific characteristics of the included literature. Analyzing the data by Revman software, and evaluating the stability of the results by Stata software. A total of 52 RCTs were included. The results showed that combined use of LNT and cisplatin could improve the treatment effect, and the difference between groups was statistically significant (RR = 1.40, 95%CI: 1.33 ~ 1.46, P < .001). And the combined use of LNT could increase the quality of life (RR = 1.45, 95%CI: 1.35 ~ 1.56, P < .001). The using of LNT could significantly decrease the incidence of gastrointestinal reactions (RR = 0.86, 95%CI: 0.78 ~ 0.94, P < .001). Sensitivity analysis results showed that there were no qualitative changes in the indicator, and suggested the possibility of publication bias. Available evidence suggested the combined use of LNT and cisplatin showed better efficacy in treating MPE without increasing ADR incidence than using cisplatin alone. LNT is an ideal treatment for MPE, which has high clinical application value.

Impact of a dedicated malignant pleural effusion clinic on the management of malignant pleural effusion

Background: Malignant pleural effusions (MPE) are common complications of advanced malignancy. The treatment of MPE is generally focused on palliation of respiratory symptoms. The main drawback of the traditional method of pleurodesis is the requirement for hospitalization. Objectives: To examine the safety, efficacy and economy of management of a dedicated MPE clinic. Methods and analysis: A retrospective cohort study was designed to compare complication rates, pleural effusion control, length of hospital stay, type of interventions, estimated hospital days saved between two three-year non-contemporary periods – before the implementation of MPE clinic and after. Results: Pre MPE clinic and MPE clinic group comprised of 115 and 161 patients respectively. The number of hospital admissions was lower in the MPE clinic period (42.4% vs 73.9%; p&lt;0.0001) and the pleural effusion control was higher in the same group (65.2% versus 51.3%; p=0.02). The estimated hospital days saved was 1001 days over 3 years. Conclusion: A dedicated malignant pleural effusion (MPE) clinic is a strategy of malignant effusion management that reduces hospital admission days and, will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. Outpatient MPE clinic is of particular importance in the setting of the health care system and the overcrowded hospitals. The ability to avoid a one week hospitalization for a palliative intervention and replace it with a simple and effective outpatient procedure should appeal to patients and administrators alike.

Expert consensus on diagnosis and treatment of malignant pleural effusion caused by lung cancer

Malignant pleural effusion (MPE) can occur in nearly all types of malignant tumors, with lung cancer being the most prevalent cause. The presence of MPE indicates an advanced stage or distant spread of the tumor, significantly reducing the patient's life expectancy. Particularly, a substantial amount of pleural effusion can impede heart and lung function, impair blood oxygen perfusion levels in the body, and greatly diminish patients' quality of life. Even when systemic treatment has alleviated the primary lung tumor in some patients, effective control over MPE remains challenging and impacts clinical outcomes. Therefore, it is crucial to implement measures for reducing or managing MPE while ensuring standardized treatment for lung cancer. In recent years, significant advancements have been made in diagnosing and treating lung cancer complicated by MPE through extensive basic and clinical research. Based on existing evidence and China's clinical practice experience, relevant experts from the China Association of Health Promotion and Education and Cancer Rehabilitation and Palliative Treatment Professional Committee of China Anti-Cancer Association (CRPC) have summarized key aspects related to diagnosis and treatment consensus opinions for lung cancer complicated by MPE. This aims to establish standardized procedures that will serve as a reference for doctors' clinical practice.

Comparison of the efficacy Talc solution injection through Chest Tube and Talcum Powder through Pleuroscopy for the Treatment of Malignant Pleural Effusion: a randomized clinical trial

Background: The aim of the present study was to compare the different outcomes and response rates of talc powder injection via chest tube and talc spray through thoracoscopy in the treatment of malignant pleural effusion in patients.&#x0D; Methods: In this randomized controlled trial, patients with malignant pleural effusion, who were hospitalized in the surgery and hematology-oncology departments of Shariati and Imam Khomeini Hospitals, were enrolled. The patients were randomly divided into two groups: chest tube and pleuroscopy, using simple randomization. The mean and standard deviation, frequency and percentage, independent sample t-tests, chi-square, and Fisher’s exact tests were used for data analysis. A p-value of less than 0.05 was considered statistically significant.&#x0D; Results: No significant difference was observed between the two groups in the incidences of chest pain, fever, and both symptoms (p &gt; 0.05). The treatment success rates among the chest tube and pleuroscopy cases were 83.3% and 100%, respectively, and there was no significant difference between the two groups (p = 0.05). Among the five patients who had a recurrence, four (80%) had lung cancer, and one (20%) had liver cancer, and this difference was significant (P = 0.003). Regarding the rate of response to the treatment according to the side with effusion, among the people who had a relapse, two people (40%) had right-sided effusion, and three others (60%) had left-sided effusion (P = 0.623).&#x0D; Conclusions: Both techniques were safe, had minor side effects, were transient, and easy to manage. However, the recurrence of the disease in the thoracoscopic pleurodesis method was significantly less than in the chest tube.&#x0D;

Old Wine in a New Bottle: Our Experience with Indwelling Pleural Catheters in Malignant Pleural Effusion

Abstract Background: Malignant pleural effusions indicate advanced stage of cancer and making the treatment decisions difficult for the treating physicians. There are multiple treatment options for the treatment of malignant pleural effusion including pleurodesis, thoracocentesis, indwelling pleural catheters (IPCs), and pleural decortication surgeries. However, there is a considerable number of patients who are not candidates for either pleurodesis or have repeated thoracocentesis, these patients can be carefully selected for management with IPCs. Aims and Objectives: To establish the use of indwelling pleural catheter in malignant pleural effusions. Materials and Methods: Patients who are not candidates for either pleurodesis or have repeated thoracocentesis, these patients can be carefully selected for management with IPCs. This is a prospective study of 23 patients with underlying trapped lung or recurrent pleural effusions who have been treated with IPCs from January 2021 to December 2022. We have used Rocket pleural catheter in this study. Results: The common primary malignancy was from lungs with the most common histologic type being adenocarcinoma type. We had good improvement in symptoms and have observed minor complications in about 21% of the individuals. Conclusion: IPC can be considered a good treatment option for patients with malignant pleural effusion with trapped lungs and patients with recurrent pleural effusions.

Chinese expert consensus on treatment of malignant pleural effusion (2023 Edition)

Malignant pleural effusion (MPE) is a pleural effusion that is caused by a malignant tumor originating in the pleura or by a metastatic malignant tumor from another site that has invaded the pleura. MPE is associated with poor prognosis. Members of the Pleural and Mediastinal Diseases Working Group (preparatory) of Chinese Thoracic Society and some external experts selected clinical issues related to the management of MPE and conducted rigorous evidence retrieval and evaluation. After several meetings and revisions of the manuscript, recommendations were made. This consensus applies to patients aged≥18 years old with MPE caused by various malignancies except for pleural mesothelioma. It included four chapters: pathogenesis of MPE, prognostic evaluation of MPE, local thoracic treatment, and systemic anticancer therapy for MPE.The main recommendations of this consensus are as follows:1. Prognosis evaluation of MPE was valuable in formulating treatment options. It is suggested to comprehensively evaluate the patient's prognosis by combining the patient's performance status, tumor type, and laboratory examination.2. It is recommended that in patients with symptomatic MPE, therapeutic thoracentesis could be used as the initial therapeutic option. Evaluate whether the lung is expandable after thoracentesis and drainage, and then develop a therapeutic regimen.3. In patients with MPE and known expandable or nonexpandable lung, an indwelling pleural catheter (IPC) is recommended as a first-line pleural management. Daily IPC drainages are recommended. In patients with MPE and expandable lung, talc pleurodesis by talc poudrage or talc slurry is recommended if the drug is accessible. Other pleurodesis agents include povidone iodine, bleomycin, and doxycycline.4. After drainage, it is suggested to consider the option of intrapleural use of recombinant human endostatin or bevacizumab alone or in combination with intrapleural chemotherapy. Intrapleural intervention including electrocautery, argon knife, cryotherapy, laser and radiofrequency ablation, is recommended for use in patients who have undergone rigorous evaluation in eligible hospitals. The use of intrapleural urokinase or streptokinase via pleural catheter is recommended for patients with symptomatic MPE and loculated effusion.5. For patients with good performance status and metastatic malignancies, systemic anti-cancer treatment is recommended as standard of care.

Quinacrine - The Winding Road from the Most Important Antimalarial of Its Time to an Indispensable Antiparasitic (Orphan) Drug of our Days.

Quinacrine, the main antimalarial drug during World War II, has had a chequered history that included the successful repurposing as an intrapleural sclerosant for the treatment of malignant pleural effusions, a non-surgical method of female sterilisation, and the use as an immunomodulatory drug in lupus erythematosus. While no longer used for these former indications, quinacrine (re)emerged as an indispensable second-line drug for the treatment of nitroimidazole-refractory Giardia duodenalis infections, and thus depicts an indispensable "orphan drug".

Minimally invasive approach with small diameter pleural drainage catheter (Easydren®) in malignant pleural effusions

Aim: Treatment of malignant pleural effusions is drainage and chemical pleurodesis. Our aim in this study is to investigate the success and complications of the procedure in patients who underwent drainage with an 8F pleural drainage catheter due to malignant pleural effusion, in the light of the literature.&#x0D; Material and Method: The study included 124 patients who underwent 8F pleural drainage catheter (Easydren®) for malignant pleural effusion between August 2020 and October 2022. Clinical, radiological and laboratory findings of all patients were obtained from the automation system and archive files. Age, gender, etiology, number and duration of catheter drainage, complications and hospital stay of the patients were recorded.&#x0D; Results: Of the patients, 67 (54.0%) were female and 57 (45.9%) were male. The mean age was 54 (31-87). A total of 136 pleural drainage catheters were applied to 124 patients. Drainage and complete reexpansion of the lung were successful in 125 (91.9%) of 136 procedures. No acute surgical complications were observed during the application of pleural drainage catheters. The mean drainage time was 4.6 days (3 – 11). The hospital stay was 5.7 days (4-12).&#x0D; Conclusion: We believe that small diameter pleural drainage catheters are as effective as conventional chest tubes for the drainage of malignant pleural effusion with greater patient comfort. Although it has the disadvantage of rarely occlusion during follow-up, it is less invasive and has fewer complications compared to tube thoracostomy.

Disparities in Access and Use of PleurX Catheters for Treatment of Malignant Pleural Effusion: A Literature and Experience Based Review

It is not uncommon for patients with metastatic cancer to experience recurrent buildup of fluid in their pleural space. These malignant pleural effusions (MPE) are often experienced in late-stage illness with limited (&lt;1 year) life expectancy and often present with shortness of breath, chest pain and discomfort, contributing to the morbidity of the patient’s illness. Tunneled indwelling pleural catheters (IPCs), including the PleurX by Beckton Dickinson (Franklin Lakes, NJ), are devices that are inserted on an outpatient basis that allow rapid and self-administered relief of symptomatic dyspnea, thereby offering an important palliative care option to patients with MPE. Current literature suggests these IPCs have enhanced efficacy compared with existing treatment options for MPE such as recurrent thoracentesis. However, the maintenance of these IPCs, including dressing changes and monitoring of fluid levels to avoid overuse or contamination, ideally requires the assistance from a family member or a home health aide. In this paper, we postulate whether the cost and maintenance demand of IPCs make them inaccessible to underserved communities, thereby contributing to the existing health disparities in health outcome by socioeconomic class. While there exists, no current literature looking at this issue specifically, existing literature does support a significantly lower utilization of health home aids in black, hispanic, and low-income populations. Our own experience at a level 1 trauma center in Newark, NJ, serving an at risk, underserved community, further suggests that the required visiting nurse and bottle replacement time and resource costs are prohibitive for this population. Given our experience and the limited literature, we believe additional research is warranted to establish plausibility of IPC use in lower socioeconomic strata.

Combination Tissue Plasminogen Activator and DNase for Loculated Malignant Pleural Effusions: A Single-center Retrospective Review.

Indwelling pleural catheters (IPCs) are frequently used for the management of malignant pleural effusions (MPEs), but drainage can be impaired by pleural loculations. We aimed to evaluate the safety and effectiveness of intrapleural tissue plasminogen activator (tPA) versus combination tPA-deoxyribonuclease (DNase) in the treatment of loculated MPE. We performed a retrospective review of patients with confirmed or presumed MPEs requiring IPC insertion. We compared the efficacy of intrapleural tPA, tPA-DNase, and procedural intervention on pleural fluid drainage. Secondary endpoints included the need for future pleural procedures (eg, thoracentesis, IPC reinsertion, chest tube insertion, or surgical intervention), IPC removal due to spontaneous pleurodesis, and IPC-related complications. Among 437 patients with MPEs, loculations developed in 81 (19%) patients. Twenty-four (30%) received intrapleural tPA, 46 (57%) received intrapleural tPA-DNase, 4 (5%) underwent a procedural intervention, and 7 (9%) received ongoing medical management. tPA improved pleural drainage in 83% of patients, and tPA-DNase improved pleural drainage in 80% of patients. tPA alone may be associated with increased rates of spontaneous pleurodesis compared with tPA-DNase. There was no difference in complications when comparing tPA, combination tPA-DNase, procedural intervention, and no therapy. Both intrapleural tPA and combination tPA-DNase appear to be safe and effective in improving pleural fluid drainage in selected patients with loculated MPE, although further studies are needed.

Current status of and progress in the treatment of malignant pleural effusion of lung cancer.

Malignant pleural effusion (MPE) is a common complication in the late stage of malignant tumors. The appearance of MPE indicates that the primary tumor has spread to the pleura or progressed to an advanced stage. The survival time of the patients will be significantly shortened, with a median survival of only a few months. There are a variety of traditional treatments, and their advantages and disadvantages are relatively clear. There are still many problems that cannot be solved by traditional methods in clinical work. The most common one is intrapleural perfusion therapy with chemotherapy drugs, but it has a large side effect of chemotherapy. At present, with the development of medical technology, there are a variety of treatment methods, and many innovative, significant and valuable treatment methods have emerged, which also bring hope for the treatment of refractory and recurrent MPE patients. Several clinical trials had confirmed that drug-carrying microparticles has less adverse reactions and obvious curative effect. However, there is still a long way to go to completely control and cure MPE, and the organic combination of clinical work and scientific research results is needed to bring dawn to refractory MPE patients.

肺癌恶性胸腔积液的治疗现状与进展

肺癌恶性胸腔积液的治疗现状与进展

胸腔灌注抗血管生成药物治疗恶性胸腔积液的研究进展

胸腔灌注抗血管生成药物治疗恶性胸腔积液的研究进展

Efficacy of Endostatin Combined with EGFR-TKIs in the Treatment of Malignant Pleural Effusion in EGFR-positive Advanced Lung Adenocarcinoma

Efficacy of Endostatin Combined with EGFR-TKIs in the Treatment of Malignant Pleural Effusion in EGFR-positive Advanced Lung Adenocarcinoma

Malignant pleural effusion: Updates in diagnosis, management and current challenges.

Malignant pleural effusion (MPE) is a common condition which often causes significant symptoms to patients and costs to healthcare systems. Over the past decade, the management of MPE has progressed enormously with large scale, randomised trials answering key questions regarding optimal diagnostic strategies and effective management strategies. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. The future goals for providing improved care for patients lies in changing the treatment paradigm from a generic pathway to personalised care, based on probability of malignancy type and survival. This article reviews the current evidence base, new discoveries and future directions in the diagnosis and management of MPE.

Thoracic perfusion of lobaplatin combined with endostar for treating malignant pleural effusions: A meta-analysis and systematic review.

Introduction:Lobaplatin is a new platinum-based cytotoxic chemotherapeutic agent. Endostar is an endogenous angiogenic inhibitor with implicated anti-tumor activity. This study was to investigate the efficacy and safety of thoracic perfusion of lobaplatin combined with endostar in the treatment of malignant pleural effusions (MPE).Methods:We searched the databases of Pubmed, the Cochrane Library, Embase, WanFang Data, and CNKI to select the studies regarding the efficacy and safety of lobaplatin combined with endostar to treat MPE. A total of 10[3–12] randomized controlled trials with 651 patients were included.Results:The objective response rate (P < .001, odds ratio = 4.08) and disease control rate (P < .001, odds ratio = 3.69) of lobaplatin combined with endostar were significantly higher than lobaplatin alone. In addition, lobaplatin combined with endostar remarkably promoted the quality of life of patients (P < .001, odds ratio = 3.93) compared with lobaplatin alone. Lobaplatin combined with endostar also promoted the quality of life of patients (P < .05, odds ratio = 2.56) compared with cisplatin combined with endostar. At the same time, the leukopenia rate (P < .05, odds ratio = .40) and the incidence of nausea and vomiting (P < .05, odds ratio = .38) of lobaplatin combined with endostar were significantly lower than that of cisplatin combined with endostar.Conclusions:The efficacy of lobaplatin combined with endostar was superior to lobaplatin alone. The safety was higher than cisplatin combined with endostar through thoracic perfusion in treating MPE, which indicated that lobaplatin combined with endostar could be the effective agent for controlling MPE.