BTS guidelines for the management of malignant pleural effusions

Antunes, George; Neville, E.; Duffy, John P.; Ali, Nabeel

doi:10.1136/thorax.58.suppl_2.ii29

Cited by 208 publications

(206 citation statements)

References 107 publications

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“…Malignant pleural effusion (MPE) is frequent in advanced cancer, especially in lung, breast, ovarian and gastrointestinal carcinoma [1,2]. One of the standard therapeutic strategies to prevent recurrent MPE is chemical pleurodesis using talcum.…”

Section: Introductionmentioning

confidence: 99%

Lysis of cancer cells by autologous T cells in breast cancer pleural effusates treated with anti-EpCAM BiTE antibody MT110

Witthauer

Schlereth

Brischwein

et al. 2008

Breast Cancer Res Treat

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In the present study, the efficacy of a new drug, i.e. the bispecific single-chain antibody MT110 targeting the epithelial antigen EpCAM and the T-cell antigen CD3 was tested ex vivo in malignant pleural effusions (MPEs). EpCAM ? epithelial cells were found in 78% of the MPEs (n = 18). Ex vivo treatment of seven MPEs resulted in a dose-dependent specific lysis of 37 ± 27% (±SD) EpCAM ? cells with 10 ng/ml (P = 0.03) and 57 ± 29.5% EpCAM ? cells with 1,000 ng/ml MT110 (P = 0.016) after 72 h. As a prerequisite for redirected lysis, stimulation of he autologous CD4 ? and CD8 ? cells in MPE by 1,000 ng/ml MT110 resulted in 21 ± 17% CD4 ? /CD25 ? and 29.4 ± 22% CD8 ? /CD25 ? cells (P = 0.016, respectively) after 72 h. This was confirmed by a 22-fold release of TNF-a and 230-fold release of IFN-c (1,000 ng/ml, 48 h, P = 0.03, respectively). Thus, relapsed breast cancer patients resistant to standard treatment might benefit from targeted therapy using MT110.Keywords Malignant pleural effusion Á Breast cancer Á Bispecific antibody Á EpCAM Á CD3 Á MT110 Á Ex vivo therapy

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Section: Introductionmentioning

confidence: 99%

Lysis of cancer cells by autologous T cells in breast cancer pleural effusates treated with anti-EpCAM BiTE antibody MT110

Witthauer

Schlereth

Brischwein

et al. 2008

Breast Cancer Res Treat

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“…Near patient testing of pleural fluid pH is an important component of this assessment for the diagnosis of pleural infection (including tuberculosis), rheumatoid pleural effusion, and esophageal rupture (3), and the prognostic assessment of malignant effusion (1,(4)(5)(6)(7). Measurement of pleural fluid pH is advocated in the literature and in management guidelines from professional societies (including the American and British Thoracic Societies [3,[8][9][10][11]) as part of first-line pleural fluid analysis.…”

mentioning

confidence: 99%

Clinically Important Factors Influencing the Diagnostic Measurement of Pleural Fluid pH and Glucose

Rahman

Mishra

Davies³

et al. 2008

Am J Respir Crit Care Med

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Rationale: Accurate pleural fluid pH and glucose measurement is a key component in the diagnosis and management of patients with pleural effusion. Standardized methods of pleural fluid collection have not been defined. Objectives: To assess the effect of common clinical factors that may distort measurement accuracy of pleural fluid pH and glucose. Methods: Ninety-two exudative pleural aspirates were collected in commercially available blood gas syringes. Measurements and Main Results: Samples were analyzed immediately using a blood gas analyzer. The effects of residual air, lidocaine, heparin, and delay in analysis (24 h) on pH and glucose measurement accuracy were assessed. Pleural fluid pH was significantly increased by residual air (mean 6 SD, 0.08 6 0.07; 95% confidence interval [CI], 0.06 to 0.09; P , 0.001) and significantly decreased by residual lidocaine (0.2 ml; mean change in pH, 20.15 6 0.09; 95% CI, 20.13 to 20.18; P , 0.001) and residual heparin (mean change in pH, 20.02 6 0.05; 95% CI, 20.01 to 20.04; P 5 0.027). Pleural fluid pH was stable at room temperature for 1 hour and significantly increased at 4 (mean 6 SD, 0.03 6 0.07; 95% CI, 0.01 to 0.04; P 5 0.003) and 24 hours (0.05 6 0.12; 95% CI, 0.03 to 0.08; P , 0.001). Pleural fluid glucose concentration was not clinically significantly altered by residual air, lidocaine (up to 0.4 ml), or 24-hour analysis delay. Conclusions: Accuracy of measured pleural pH is critically dependent on sample collection method. Residual air, lidocaine, and analysis delay significantly alter pH and may impact on clinical management. Pleural fluid glucose concentration is not significantly influenced by these factors. Protocols defining appropriate sampling and analysis methods are needed.

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“…The most common cause of malignant pleural effusion (MPE) is lung cancer (37%) (3,4). The presence of MPE indicates disseminated disease and reduces survival (5). The goal of management of MPE is often palliation (6), as quality of life diminishes with increased amounts of PE (7).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…A number of investigational sclerosing agents with varying response rates are currently available for pleurodesis, for example, tetracycline, talc (slurry or poudrage), bleomycin, doxycycline, chemotherapeutic agents (cisplatin, cytosine arabinoside, and mitoxantrone) among others (5,6). Talc is purported to be the most effective (70-100%) for preventing MPE recurrence (5,6,8). Despite its high success rate, talc is not an ideal sclerosant due to associated adverse effects following its instillation: dyspnea, fever, chest pain, atelectasis, pneumonia, arrhythmias, empyema, and acute respiratory failure, which could progress to acute respiratory distress syndrome (6).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A pilot study—is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer?

Sreter¹,

Jakopović

Janevski

et al. 2016

Ann. Transl. Med.

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BTS guidelines for the management of malignant pleural effusions

Cited by 208 publications

References 107 publications

Lysis of cancer cells by autologous T cells in breast cancer pleural effusates treated with anti-EpCAM BiTE antibody MT110

Lysis of cancer cells by autologous T cells in breast cancer pleural effusates treated with anti-EpCAM BiTE antibody MT110

Clinically Important Factors Influencing the Diagnostic Measurement of Pleural Fluid pH and Glucose

A pilot study—is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer?

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