ERS/EACTS statement on the management of malignant pleural effusions

Abstract

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeon alike. In recent years, several well-designed, randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multi-disciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE, and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters are effective at managing the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.

Novel insights into the systemic treatment of lung cancer malignant pleural effusion

“…These “liquid biopsy” methods have proven useful in lung cancer patients in the detection of EGFR mutations, and identification of T790M mutations conferring resistance to targeted therapy, even months before clinical evidence of progression during TKIs treatment . While several of these assays have been already approved for use in NSCLC management, they are not yet universally accessible …”

Development and Maintenance of a Pleural Disease Service: Role of the “Pleurologist”

“…Pleural medicine has excelled in the production of highquality randomized controlled trials that have informed international evidence-based guidelines. [34][35][36] This highquality research must continue and it is vital that patients with pleural disease are offered access to research trials, supported by a dedicated research team within the pleural service. This multidisciplinary pleural team requires connections with thoracic oncologists who can formulate the management plan for the underlying malignancy causing a MPE.…”

Malignant Pleural Effusions: Management Options

“…The European Respiratory Society/European Association for Cardio-Thoracic Surgeons suggests that although no clinical benefits have been demonstrated, few alternatives are available. 41 It is thought that results from TIME3 may have been confounded by patient selection. Approximately 80% of patients enrolled had a performance status of 3 to 4 resulting in a relatively frail cohort in whom improvements in dyspnea may have been more difficult to detect or perceive.…”