Management of malignant pleural effusions

Abstract

Purpose of review: Although malignant pleural effusions are a common medical problem, research into their optimal management remains sparse. The aim of this review is to summarise recent developments in this area.

Recent findings: Talc remains the most efficacious pleurodesis agent. However, concerns remain about its side effect profile, with a number of cases of acute respiratory distress syndrome documented in the literature. A recent trial showed that using calibrated talc particles reduced the risk of morbidity from this procedure. Work on novel pleurodesis agents, such as transforming growth factor-beta, appears to induce pleurodesis in animal models without any unwanted side effects. This is a promising development and human trials are awaited. With regard to mesothelioma, recent chemotherapy trials with pemetrexed/cisplatin and raltitrexed/cisplatin are encouraging and appear, for the first time, to offer a small but real survival advantage.

Summary: In the authors' opinion, the major developments in the management of malignant effusions during the past year are the development of safer pleurodesis agents and the promise of better combination chemotherapy agents for the treatment of mesothelioma.