scholarly journals Technique of pressurized intrathoracic aerosol chemotherapy (PITAC) for malignant pleural effusion

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Gabrielle Drevet ◽  
Jean-Michel Maury ◽  
Naoual Bakrin ◽  
François Tronc
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Vital Signs ◽  
Bronchial Tube ◽  
Intrathoracic Pressure ◽  
Intercostal Space ◽  
Novel Therapy ◽  
Apical Position ◽  
Surgical Smoke

AbstractObjectivesMalignant pleural effusion (MPE) is a devastating evolution of several malignancies. Pressurized intrathoracic aerosol chemotherapy (PITAC) might be a novel therapy option in MPE.MethodsPITAC is considered for patients with MPE with a performance status <2 and without other metastatic sites. General anesthesia is administered and a double-lumen bronchial tube is inserted. The patient is placed in a lateral decubitus position, and the operation is performed after ipsilateral lung exclusion. Two 12-mm balloon trocars are inserted—one in the seventh intercostal space in the mid-axillary line and one in the fifth intercostal space in the anterior axillary line. Extent of pleural disease and volume of MPE are documented. MPE is removed and parietal pleural biopsy are performed. An intrathoracic pressure of 12 mmHg CO2 is established, and a combination of Cisplatin (10.5 mg/m2 in a total volume of 150 cc NaCl 0.9%) and Doxorubicin (2.1 mg/m2 in a total volume of 50 cc NaCl 0.9%) are aerosolized via nebulizer in the pleural cavity. Vital signs and nebulization are remote-controlled. After 30 min, the remaining toxic aerosol is exhausted using a closed surgical smoke evacuation system. A 24Fr chest tube is inserted in postero-apical position with continuous negative pressure of 20 cm H2O. When needed, PITAC may be repeated every six weeks in alternate with systemic chemotherapy.ResultsIn our hands, the technique above has shown to be feasible and safe.ConclusionsFurther studies are needed to assess the potential symptomatic and oncological benefits of PITAC in MPE.

Prognostic factors in patients with malignant pleural effusion: Is it possible to predict mortality in patients with good performance status?

2016 ◽  
Vol 113 (5) ◽  
pp. 570-574 ◽  
Author(s):  
Fernando Conrado Abrao ◽  
Renata D'Alpino Peixoto ◽  
Igor Renato Louro Bruno de Abreu ◽  
Maria Cláudia Janini ◽  
Geisa Garcia Viana ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Good Performance Status

SMALL-BORE CATHETERS FOR MANAGEMENT OF MALIGNANT PLEURAL EFFUSION IN LOW PERFORMANCE STATUS OUTPATIENTS

CHEST Journal ◽  
2007 ◽  
Vol 132 (4) ◽  
pp. 432A
Author(s):  
Ricardo M. Terra ◽  
Lisete R. Teixeira ◽  
Francisco S. Vargas ◽  
Paulo M. Pego-Fernades ◽  
Eduardo H. Genofre ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Low Performance

scholarly journals Prediction of patients with a tumor proportion score >50% who do not respond to first-line monotherapy with pembrolizumab

2020 ◽  
Author(s):  
Mitsunori Morita ◽  
Motohiro Tamiya ◽  
Daichi Fujimoto ◽  
Akihiro Tamiya ◽  
Hidekazu Suzuki ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Group Performance ◽  
Performance Status ◽  
Univariate Analysis ◽  
Response To Treatment ◽  
Smoking History ◽  
First Line ◽  
Status Score ◽  
Performance Status Score

Abstract Background: Pembrolizumab is effective as first-line therapy against advanced non-small cell lung cancer (NSCLC) in patients with programmed death ligand-1 (PD-L1) expression levels ≥50%. However, it is not effective in all patients, and the factors predicting responses among this population remain unknown. Methods: We retrospectively analyzed patients with NSCLC and a PD-L1 tumor proportion score (TPS) >50%, who received first-line monotherapy with pembrolizumab from February 1, 2017 to April 30, 2018. The study included 11 hospitals, which participated in the Hanshin Oncology clinical Problem Evaluation group (HOPE). We analyzed the differences between responders and non-responders in terms of age, sex, performance status score, degree of progression, histological type, smoking history, expression of PD-L1, use of steroids prior to treatment, metastasis site, and laboratory data. Results: A total of 205 patients were included in this study. Of those, 108 patients exhibiting complete or partial response were defined as responders. Those exhibiting progressive disease (N=52) were defined as non-responders. In the univariate analysis, Eastern Cooperative Oncology Group performance status score ≥2 (p=0.0832), stage IV disease or recurrence (p=0.0487), PD-L1 TPS 50–89% (p=0.0657), use of steroids prior to the administration of pembrolizumab (p=0.0243), malignant pleural effusion (p=0.0032), and baseline C-reactive protein (CRP) levels >1.0 mg/dL (p=0.0390) were significantly associated with non-response to treatment. In the multivariate analysis, use of steroids prior to the administration of pembrolizumab (odds ratio [OR]: 5.86; 95% confidence interval [CI]: 1.32–31.8; p=0.0200), malignant pleural effusion (OR: 2.68; 95% CI: 1.15–6.35; p=0.0228), and baseline CRP >1.0 mg/dL (OR: 2.17; 95% CI: 1.03–4.68; p=0.0402) were significantly associated with non-response to treatment. Conclusion: In real-world patients with NSCLC and a PD-L1 TPS ≥50%, use of steroids prior to treatment, malignant pleural effusion, and baseline CRP levels >1.0mg/dL reduced the response of first-line monotherapy with pembrolizumab.

scholarly journals Prediction of patients with a tumor proportion score >50% who do not respond to first-line monotherapy with pembrolizumab

2019 ◽  
Author(s):  
Mitsunori Morita ◽  
Motohiro Tamiya ◽  
Daichi Fujimoto ◽  
Akihiro Tamiya ◽  
Hidekazu Suzuki ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Group Performance ◽  
Performance Status ◽  
Univariate Analysis ◽  
Response To Treatment ◽  
Smoking History ◽  
First Line ◽  
Status Score ◽  
Performance Status Score

Abstract Background: Pembrolizumab is effective as first-line therapy against advanced non-small cell lung cancer (NSCLC) in patients with programmed death ligand-1 (PD-L1) expression levels ≥50%. However, it is not effective in all patients, and the factors predicting responses among this population remain unknown. Methods: We retrospectively analyzed patients with NSCLC and a PD-L1 tumor proportion score (TPS) >50%, who received first-line monotherapy with pembrolizumab from February 1, 2017 to April 30, 2018. The study included 11 hospitals, which participated in the Hanshin Oncology clinical Problem Evaluation group (HOPE). We analyzed the differences between responders and non-responders in terms of age, sex, performance status score, degree of progression, histological type, smoking history, expression of PD-L1, use of steroids prior to treatment, metastasis site, and laboratory data. Results: A total of 205 patients were included in this study. Of those, 108 patients exhibiting complete or partial response were defined as responders. Those exhibiting progressive disease (N=52) were defined as non-responders. In the univariate analysis, Eastern Cooperative Oncology Group performance status score ≥2 (p=0.0832), stage IV disease or recurrence (p=0.0487), PD-L1 TPS 50–89% (p=0.0657), use of steroids prior to the administration of pembrolizumab (p=0.0243), malignant pleural effusion (p=0.0032), and baseline C-reactive protein (CRP) levels >1.0 mg/dL (p=0.0390) were significantly associated with non-response to treatment. In the multivariate analysis, use of steroids prior to the administration of pembrolizumab (odds ratio [OR]: 5.86; 95% confidence interval [CI]: 1.32–31.8; p=0.0200), malignant pleural effusion (OR: 2.68; 95% CI: 1.15–6.35; p=0.0228), and baseline CRP >1.0 mg/dL (OR: 2.17; 95% CI: 1.03–4.68; p=0.0402) were significantly associated with non-response to treatment. Conclusion: In real-world patients with NSCLC and a PD-L1 TPS ≥50%, use of steroids prior to treatment, malignant pleural effusion, and baseline CRP levels >1.0mg/dL reduced the effectiveness of first-line monotherapy with pembrolizumab.

scholarly journals Prediction of patients with a tumor proportion score >50% who do not respond to first-line monotherapy with pembrolizumab

2019 ◽  
Author(s):  
Mitsunori Morita ◽  
Motohiro Tamiya ◽  
Daichi Fujimoto ◽  
Akihiro Tamiya ◽  
Hidekazu Suzuki ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Group Performance ◽  
Performance Status ◽  
Univariate Analysis ◽  
Response To Treatment ◽  
Smoking History ◽  
First Line ◽  
Status Score ◽  
Performance Status Score

Abstract Background: Pembrolizumab is effective as first-line therapy against advanced non-small cell lung cancer (NSCLC) in patients with programmed death ligand-1 (PD-L1) expression levels ≥50%. However, it is not effective in all patients, and the factors predicting responses among this population remain unknown. Methods: We retrospectively analyzed patients with NSCLC and a PD-L1 tumor proportion score (TPS) >50%, who received first-line monotherapy with pembrolizumab from February 1, 2017 to April 30, 2018. The study included 11 hospitals, which participated in the Hanshin Oncology clinical Problem Evaluation group (HOPE). We analyzed the differences between responders and non-responders in terms of age, sex, performance status score, degree of progression, histological type, smoking history, expression of PD-L1, use of steroids prior to treatment, metastasis site, and laboratory data. Results: A total of 205 patients were included in this study. Of those, 108 patients exhibiting complete or partial response were defined as responders. Those exhibiting progressive disease (N=52) were defined as non-responders. In the univariate analysis, Eastern Cooperative Oncology Group performance status score ≥2 (p=0.0832), stage IV disease or recurrence (p=0.0487), PD-L1 TPS 50–89% (p=0.0657), use of steroids prior to the administration of pembrolizumab (p=0.0243), malignant pleural effusion (p=0.0032), and baseline C-reactive protein (CRP) levels >1.0 mg/dL (p=0.0390) were significantly associated with non-response to treatment. In the multivariate analysis, use of steroids prior to the administration of pembrolizumab (odds ratio [OR]: 5.86; 95% confidence interval [CI]: 1.32–31.8; p=0.0200), malignant pleural effusion (OR: 2.68; 95% CI: 1.15–6.35; p=0.0228), and baseline CRP >1.0 mg/dL (OR: 2.17; 95% CI: 1.03–4.68; p=0.0402) were significantly associated with non-response to treatment. Conclusion: In real-world patients with NSCLC and a PD-L1 TPS ≥50%, use of steroids prior to treatment, malignant pleural effusion, and baseline CRP levels >1.0mg/dL reduced the effectiveness of first-line monotherapy with pembrolizumab.

scholarly journals Eosinophilic pleural effusion due to lung cancer has a better prognosis than non-eosinophilic malignant pleural effusion

2021 ◽  
Author(s):  
Eiji Takeuchi ◽  
Yoshio Okano ◽  
Hisanori Machida ◽  
Katsuhiro Atagi ◽  
Yoshihiro Kondou ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pleural Effusion ◽  
Cancer Patients ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Univariate Analysis ◽  
Eastern Cooperative Oncology Group ◽  
Hospital Organization ◽  
Lung Cancer Patients ◽  
Eosinophilic Pleural Effusion

Abstract Objective Tumor-related eosinophilia may have extended survival benefits for some cancer patients. However, there has been no report on the prognosis difference between eosinophilic pleural effusion (EPE) and non-EPE in lung cancer patients. Our study aimed to investigate the prognosis difference between EPE and non-EPE due to lung cancer. Patients and methods We retrospectively reviewed patients diagnosed with lung cancer who presented with malignant pleural effusion (MPE) between May 2007 and September 2020 at the National Hospital Organization Kochi Hospital. EPE is defined as pleural fluid with a nucleated cell count containing 10% or more eosinophils. Results A total of 152 patients were included: 89 were male (59%). The median age was 74.4 years (range 37–101), and all patients were pathologically shown to have MPE. Most patients (140; 92%) had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0/1. Twenty patients had EPE. The median overall survival (OS) of all 152 lung cancer patients with MPE was 298 days. The median OS of the patients with EPE was 766 days, and the median OS of the patients with non-EPE was 252 days. Kaplan–Meier univariate analysis showed that lung cancer patients with EPE had a significantly better prognosis than patients with non-EPE (P < 0.05). Cox proportional regression analysis showed that EPE, ECOG PS, sex, and the neutrophil-to-lymphocyte ratio in the serum (sNLR) may be independent prognostic factors affecting survival in patients with MPE. Conclusion Lung cancer patients with EPE have a better prognosis than those with non-EPE.

scholarly journals Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status

Clinics ◽  
2011 ◽  
Vol 66 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Ricardo Mingarini Terra ◽  
Lisete Ribeiro Teixeira ◽  
Benoit Jacques Bibas ◽  
Paulo Manuel Pego-Fernandes ◽  
Francisco Suso Vargas ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Performance Status ◽  
Low Performance

scholarly journals Contemporary best practice in the management of malignant pleural effusion

2018 ◽  
Vol 12 ◽  
pp. 175346661878509 ◽  
Author(s):  
Coenraad F.N. Koegelenberg ◽  
Jane A. Shaw ◽  
Elvis M. Irusen ◽  
Y. C. Gary Lee
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Best Practice ◽  
Performance Status ◽  
Current Evidence ◽  
Pleural Drainage ◽  
Chemical Pleurodesis ◽  
Indwelling Pleural Catheter ◽  
Pleural Catheter ◽  
High Degree

Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient’s wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.

scholarly journals Intrapleural Administration With Rh-Endostatin and Chemical Irritants in the Control of Malignant Pleural Effusion: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Cheng-Qiong Wang ◽  
Xiao-Rong Huang ◽  
Min He ◽  
Xiao-Tian Zheng ◽  
Hong Jiang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pleural Effusion ◽  
Clinical Response ◽  
Malignant Pleural Effusion ◽  
Progressive Disease ◽  
Karnofsky Performance Status ◽  
Meta Analysis ◽  
Performance Status ◽  
Current Evidence ◽  
Chemical Irritants

IntroductionA modified and recombinant human endostatin (Rh-endostatin) is often used in the control of malignant pleural effusion (MPE) through intrapleural infusion.ObjectivesTo demonstrate the clinical response, survival, and safety of Rh-endostatin plus chemical irritants, their optimal combinations, treatment threshold, and optimal usage, we performed a new systematic review and meta-analysis.MethodologyAll randomized controlled trials (RCTs) were collected from Chinese and English electronic databases (from inception until August 2020). We pooled the data using a series of meta-analyses and summarized the evidence quality following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsWe included 75 RCTs recruiting 4,678 patients, which reported six combinations for Rh-endostatin plus chemical irritants. Among the six combinations, only Rh-endostatin plus cisplatin (DDP) with enough trials might improve the complete response [2.29 (1.93, 2.71)] and quality of life [3.01 (2.49, 3.63)] and reduce treatment failure [0.29 (0.25, 0.33)] and progressive disease [0.27 (0.22, 0.34)]. It might not increase the risk of adverse drug reactions. For patients with lung cancer, moderate to massive effusion, initial treatment, Karnofsky Performance Status (KPS) score ≥60, or anticipated survival time ≥3 months, Rh-endostatin (30–45 mg each time, once or twice a week 3–4 times) plus DDP (30–60 mg/m2) obtained a significant improvement in clinical response and a reduction of failure and progressive disease. Most results had good robustness and moderate quality.ConclusionsCurrent evidence suggests that Rh-endostatin with DDP may be an optimal combination, which may improve clinical response and reduce failure and progressive disease with good safety. Rh-endostatin (30–40 mg each time, once or twice a week 3–4 times) with DDP (30–40 mg/m2) may be an optimal usage for achieving an ideal response.

scholarly journals Prediction of patients with a tumor proportion score >50% who do not respond to first-line monotherapy with pembrolizumab

2020 ◽  
Author(s):  
Mitsunori Morita ◽  
Motohiro Tamiya ◽  
Daichi Fujimoto ◽  
Akihiro Tamiya ◽  
Hidekazu Suzuki ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Group Performance ◽  
Performance Status ◽  
Univariate Analysis ◽  
Response To Treatment ◽  
Smoking History ◽  
First Line ◽  
Status Score ◽  
Performance Status Score

Abstract Background: Pembrolizumab is effective as first-line therapy against advanced non-small cell lung cancer (NSCLC) in patients with programmed death ligand-1 (PD-L1) expression levels ≥50%. However, it is not effective in all patients, and the factors predicting responses among this population remain unknown. Methods: We retrospectively analyzed patients with NSCLC and a PD-L1 tumor proportion score (TPS) >50%, who received first-line monotherapy with pembrolizumab from February 1, 2017 to April 30, 2018. The study included 11 hospitals, which participated in the Hanshin Oncology clinical Problem Evaluation group (HOPE). We analyzed the differences between responders and non-responders in terms of age, sex, performance status score, degree of progression, histological type, smoking history, expression of PD-L1, use of steroids prior to treatment, metastasis site, and laboratory data. Results: A total of 205 patients were included in this study. Of those, 108 patients exhibiting complete or partial response were defined as responders. Those exhibiting progressive disease (N=52) were defined as non-responders. In the univariate analysis, Eastern Cooperative Oncology Group performance status score ≥2 (p=0.0832), stage IV disease or recurrence (p=0.0487), PD-L1 TPS 50–89% (p=0.0657), use of steroids prior to the administration of pembrolizumab (p=0.0243), malignant pleural effusion (p=0.0032), and baseline C-reactive protein (CRP) levels >1.0 mg/dL (p=0.0390) were significantly associated with non-response to treatment. In the multivariate analysis, use of steroids prior to the administration of pembrolizumab (odds ratio [OR]: 5.86; 95% confidence interval [CI]: 1.32–31.8; p=0.0200), malignant pleural effusion (OR: 2.68; 95% CI: 1.15–6.35; p=0.0228), and baseline CRP >1.0 mg/dL (OR: 2.17; 95% CI: 1.03–4.68; p=0.0402) were significantly associated with non-response to treatment. Conclusion: In real-world patients with NSCLC and a PD-L1 TPS ≥50%, use of steroids prior to treatment, malignant pleural effusion, and baseline CRP levels >1.0mg/dL reduced the response of first-line monotherapy with pembrolizumab.

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