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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.


Effusion-recurrence-free period in various sub-groups. Patients receiving TKIs had longest effusion-recurrence-free period of 352 days (close to a year) even without talc-pleurodesis, in comparison to patients with chemotherapy and best supportive care. The solid horizontal line within the box represents the median, and the dotted horizontal line represents the mean.
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Figure 3: Effusion-recurrence-free period in various sub-groups. Patients receiving TKIs had longest effusion-recurrence-free period of 352 days (close to a year) even without talc-pleurodesis, in comparison to patients with chemotherapy and best supportive care. The solid horizontal line within the box represents the median, and the dotted horizontal line represents the mean.

Mentions: Eight patients received chemotherapy as first line therapy. Although not reaching statistical significance (p=0.64), effusion-recurrence-free period was longer (5 months) in those undergoing talc pleurodesis in addition to chemotherapy (n=2) vs. 1.1 month in those without talc pleurodesis (n=6) (Table 3, Fig. 3).


Can EGFR-Tyrosine Kinase Inhibitors (TKI) Alone Without Talc Pleurodesis Prevent Recurrence of Malignant Pleural Effusion (MPE) in Lung Adenocarcinoma
Effusion-recurrence-free period in various sub-groups. Patients receiving TKIs had longest effusion-recurrence-free period of 352 days (close to a year) even without talc-pleurodesis, in comparison to patients with chemotherapy and best supportive care. The solid horizontal line within the box represents the median, and the dotted horizontal line represents the mean.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Effusion-recurrence-free period in various sub-groups. Patients receiving TKIs had longest effusion-recurrence-free period of 352 days (close to a year) even without talc-pleurodesis, in comparison to patients with chemotherapy and best supportive care. The solid horizontal line within the box represents the median, and the dotted horizontal line represents the mean.
Mentions: Eight patients received chemotherapy as first line therapy. Although not reaching statistical significance (p=0.64), effusion-recurrence-free period was longer (5 months) in those undergoing talc pleurodesis in addition to chemotherapy (n=2) vs. 1.1 month in those without talc pleurodesis (n=6) (Table 3, Fig. 3).

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.