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. 2025 Feb 28;17(2):687-694.
doi: 10.21037/jtd-24-1541. Epub 2025 Feb 27.

Efficacy and safety of pleurodesis for lung cancer patients with interstitial lung disease

Hirokazu Iso  1 , Akihiko Miyanaga  1 , Yozo Sato  1 , Yukari Shirakura  1 , Kaoruko Shinbu  1 , Tomoyasu Inoue  1 , Atsuhiro Nagano  1 , Kazuhito Misawa  1 , Takehiro Tozuka  1 , Akari Murata  1 , Katsuyuki Higa  1 , Susumu Takeuchi  1 , Masaru Matsumoto  1 , Koichiro Kamio  1 , Kazuo Kasahara  1 , Masahiro Seike  1
Affiliations

Efficacy and safety of pleurodesis for lung cancer patients with interstitial lung disease

Hirokazu Iso et al. J Thorac Dis. .

Abstract

Background: Managing malignant pleural effusion (MPE) with pleurodesis is essential for symptom relief and minimizing the need for repeated thoracentesis. Interstitial lung disease (ILD) is one of the most common complications associated with advanced lung cancer. However, the efficacy and safety of pleurodesis for MPE secondary to lung cancer with ILD remains unclear. This study aimed to evaluate the efficacy and safety of pleurodesis in this population.

Methods: This study was a single-center retrospective analysis. The cases of pleurodesis in patients with MPE secondary to lung cancer complicated with ILD at Nippon Medical School Hospital (Tokyo, Japan) between January 2010 and December 2022 were included.

Results: Of the 26 lung cancer patients with ILD who underwent pleurodesis were analyzed. Fourteen patients received talc and 12 patients received minocycline, respectively. Talc was used in 10 out of 14 patients with drug-induced ILD and radiation-induced lung injury (RILI). In contrast, minocycline was used in 10 out of 12 patients with idiopathic interstitial pneumonias (IIPs). One month after pleurodesis, the efficacy for pleural adhesions was 64.3% and 50.0% in the talc and minocycline groups. The presence of a partially expanded lung before pleurodesis was a predictive factor for failure [odds ratio: 7.00, 95% confidence interval (CI): 1.20-40.83, P=0.04]. When excluding the patients presenting partially expanded lung, the efficacy rate was 77.8% and 71.4% in the talc and minocycline groups. One case of grade 5 acute respiratory distress syndrome (ARDS) was observed in each group. All cases developing ARDS had been treated with systemic prednisolone against ILDs presenting ground glass opacity and consolidation within 6 months before pleurodesis.

Conclusions: Pleurodesis is considered to be one of the treatment options against MPE in patients with ILD. However, two cases of ARDS were observed; thus, clinicians should carefully consider the indication of pleurodesis in the patients who had the recent onset of ILD and were treated with systemic prednisolone.

Keywords: Lung cancer; interstitial lung disease (ILD); malignant pleural effusion (MPE); pleurodesis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1541/coif). Akihiko Miyanaga received these horaria from AstraZeneca, Nippon Kayaku, Merck, Kyowa Kirin, and Pfizer. T.T. has received honoraria from AstraZeneca and Chugai Pharmaceutical. Masaru Matsumoto has received honoraria from Astra Zeneca, Chugai Pharmaceutical, Taiho Pharmaceutical, and Ono Pharmaceutical. Kazuo Kasahara has received honoraria from MSD, AstraZeneca, Chugai Pharmaceutical, Bristol-Myers Squib, Taiho Pharmaceutical, Pfizer, Eli Lilly, and Boehringer Ingelheim, and has received consulting fees from Chugai Pharmaceutical, Taiho Pharmaceutical, Eli Lilly, AstraZeneca, and has patents with Boehringer Ingelheim serves on boards for AstraZeneca and Eli Lilly. M.S. had grants or contracts: Taiho Pharmaceutica, Chugai Pharmaceutical, Eli Lilly, Nippon Kayaku, and Kyowa Hakko Kirin, as well as honoraria from AstraZeneca, MSD K.K, Chugai Pharmaceutical, Taiho Pharmaceutical, Eli Lilly, Ono Pharmaceutical, Bristol-Myers Squibb, Nippon Boehringer Ingelheim, Pfizer, Novartis, Takeda Pharmaceutical, Kyowa Hakko Kirin, Nippon Kayaku, Daiichi-Sankyo Company, Merck Biopharma, and Amgen Inc. The other authors have no conflicts of interest to declare.

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