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Can EGFR-Tyrosine Kinase Inhibitors (TKI) Alone Without Talc Pleurodesis Prevent Recurrence of Malignant Pleural Effusion (MPE) in Lung Adenocarcinoma

View Article: PubMed Central - PubMed

ABSTRACT

Abstract: Background and Objective: Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) are effective against lung adenocarcinoma. However, limited data is available assessing the effectiveness of EGFR-TKI use in preventing re-accumulation of MPE. To our knowledge, there is no literature on comparison of talc pleurodesis with EGFR-TKIs alone on re-accumulation of MPE in Asian population. We investigated if EGFR-TKI therapy for advanced lung adenocarcinoma with malignant pleural effusion (MPE) is also successful in preventing pleural fluid re-accumulation following initial drainage.

Methods: An observational cohort study of patients with lung adenocarcinoma and MPE in the year 2012 was conducted.

Results: 70 patients presented with MPE from lung adenocarcinoma. Fifty six underwent EGFR mutation testing of which 39 (69.6%) had activating EGFR mutation and 34 (87.1%) received TKI. 20 were managed by pleural fluid drainage only whereas 14 underwent talc pleurodesis following pleural fluid drainage. Time taken for the pleural effusion to re-accumulate in those with and without pleurodesis was 9.9 vs. 11.7 months, p=0.59 respectively. More patients (n=10, 25.6%) with activating EGFR mutation presented with complete opacification (white-out) of the hemithorax compared to none without activating EGFR mutation (p=0.02).

Conclusion: In TKI eligible patients, early talc pleurodesis may not confer additional benefit in preventing re-accumulation of pleural effusion and may be reserved for non-adenocarcinoma histology, or EGFR negative adenocarcinoma. Complete opacification of the hemithorax on presentation may serve as an early radiographic signal of positive EGFR mutation status.

No MeSH data available.


Related in: MedlinePlus

Flow Diagram of the Patients. Seventy patients had malignant pleural effusion from adenocarcinoma out of which 27 received talc pleurodesis and 43 did not. In terms of treatment of lung cancer, among patients receiving talc pleurodesis, 14 received TKI`s, 2 received chemotherapy, and 11 received nil (best supportive care), as cancer specific therapy. Among patients not receiving talc pleurodesis, 20 received TKI`s, 6 received chemotherapy, and 17 received nil (best supportive care), as cancer specific therapy.
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Figure 2: Flow Diagram of the Patients. Seventy patients had malignant pleural effusion from adenocarcinoma out of which 27 received talc pleurodesis and 43 did not. In terms of treatment of lung cancer, among patients receiving talc pleurodesis, 14 received TKI`s, 2 received chemotherapy, and 11 received nil (best supportive care), as cancer specific therapy. Among patients not receiving talc pleurodesis, 20 received TKI`s, 6 received chemotherapy, and 17 received nil (best supportive care), as cancer specific therapy.

Mentions: A total of 70 patients with lung adenocarcinoma presenting with a MPE at the time of initial diagnosis in 2012 were studied. Median age (range) was 72 (38-92) years and 33 (47.1%) were female. Twenty seven (38.5%) patients underwent pleurodesis in the whole group (Fig. 2). Pleurodesis was done at median (range) interval of 7 (2-22) days after chest drain insertion (Table 1).


Can EGFR-Tyrosine Kinase Inhibitors (TKI) Alone Without Talc Pleurodesis Prevent Recurrence of Malignant Pleural Effusion (MPE) in Lung Adenocarcinoma
Flow Diagram of the Patients. Seventy patients had malignant pleural effusion from adenocarcinoma out of which 27 received talc pleurodesis and 43 did not. In terms of treatment of lung cancer, among patients receiving talc pleurodesis, 14 received TKI`s, 2 received chemotherapy, and 11 received nil (best supportive care), as cancer specific therapy. Among patients not receiving talc pleurodesis, 20 received TKI`s, 6 received chemotherapy, and 17 received nil (best supportive care), as cancer specific therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4997927&req=5

Figure 2: Flow Diagram of the Patients. Seventy patients had malignant pleural effusion from adenocarcinoma out of which 27 received talc pleurodesis and 43 did not. In terms of treatment of lung cancer, among patients receiving talc pleurodesis, 14 received TKI`s, 2 received chemotherapy, and 11 received nil (best supportive care), as cancer specific therapy. Among patients not receiving talc pleurodesis, 20 received TKI`s, 6 received chemotherapy, and 17 received nil (best supportive care), as cancer specific therapy.
Mentions: A total of 70 patients with lung adenocarcinoma presenting with a MPE at the time of initial diagnosis in 2012 were studied. Median age (range) was 72 (38-92) years and 33 (47.1%) were female. Twenty seven (38.5%) patients underwent pleurodesis in the whole group (Fig. 2). Pleurodesis was done at median (range) interval of 7 (2-22) days after chest drain insertion (Table 1).

View Article: PubMed Central - PubMed

ABSTRACT

Abstract: Background and Objective: Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) are effective against lung adenocarcinoma. However, limited data is available assessing the effectiveness of EGFR-TKI use in preventing re-accumulation of MPE. To our knowledge, there is no literature on comparison of talc pleurodesis with EGFR-TKIs alone on re-accumulation of MPE in Asian population. We investigated if EGFR-TKI therapy for advanced lung adenocarcinoma with malignant pleural effusion (MPE) is also successful in preventing pleural fluid re-accumulation following initial drainage.

Methods: An observational cohort study of patients with lung adenocarcinoma and MPE in the year 2012 was conducted.

Results: 70 patients presented with MPE from lung adenocarcinoma. Fifty six underwent EGFR mutation testing of which 39 (69.6%) had activating EGFR mutation and 34 (87.1%) received TKI. 20 were managed by pleural fluid drainage only whereas 14 underwent talc pleurodesis following pleural fluid drainage. Time taken for the pleural effusion to re-accumulate in those with and without pleurodesis was 9.9 vs. 11.7 months, p=0.59 respectively. More patients (n=10, 25.6%) with activating EGFR mutation presented with complete opacification (white-out) of the hemithorax compared to none without activating EGFR mutation (p=0.02).

Conclusion: In TKI eligible patients, early talc pleurodesis may not confer additional benefit in preventing re-accumulation of pleural effusion and may be reserved for non-adenocarcinoma histology, or EGFR negative adenocarcinoma. Complete opacification of the hemithorax on presentation may serve as an early radiographic signal of positive EGFR mutation status.

No MeSH data available.


Related in: MedlinePlus