Malignant pleural effusion: from bench to bedside

Abstract

Malignant pleural effusion (MPE) is a common but serious condition that is related with poor quality of life, morbidity and mortality. Its incidence and associated healthcare costs are rising and its management remains palliative, with median survival ranging from 3 to 12 months. During the last decade there has been significant progress in unravelling the pathophysiology of MPE, as well as its diagnostics, imaging, and management. Nowadays, formerly bed-ridden patients are genotyped, phenotyped, and treated on an ambulatory basis. This article attempts to provide a comprehensive overview of current advances in MPE from bench to bedside. In addition, it highlights unanswered questions in current clinical practice and suggests future directions for basic and clinical research in the field. @ERSpublications This review provides up to date knowledge for malignant pleural effusion covering aspects from bench to bedside http://ow.ly/10w7vN

Management of malignant pleural effusion: challenges and solutions

“…Although not discussed in this review, the study of the molecular biology of MPE and the role of biomarkers in MPE diagnosis and prognosis have been growing in recent years and have been reviewed recently 90. Improved understanding of the molecular causes of MPE and underlying malignancies should promote clinical studies of targeted therapies against MPE in the near future.…”

“…Improved understanding of the molecular causes of MPE and underlying malignancies should promote clinical studies of targeted therapies against MPE in the near future. With the increased use of IPCs allowing long-term outpatient access to the pleural cavity, this makes them an ideal potential portal for local drug delivery 90. In addition to IPC-delivered bacterial moieties that have been evaluated as potential immunomodulators against MPE,91,92 a number of agents are currently under development and the results are eagerly awaited.…”

Current best practice in the evaluation and management of malignant pleural effusions

“…In general these biomarkers have demonstrated poor specificity and sensitivity and results have not been validated in subsequent studies [Psallidas et al 2016;Sriram et al 2011]. The use of established biomarkers, including carcinoembryonic antigen and cancer antigens (CAs) 15-3 and 125, has limited diagnostic value in determining the aetiology of MPE [Porcel et al 2004] The most promising biomarker to date is mesothelin, a cell-surface glycoprotein that is overexpressed in mesothelioma [Chang et al 1992].…”

“…Various biomarkers have been proposed as noninvasive tests to help distinguish between benign and malignant pleural disease, and to give information on prognosis or treatment outcomes [Psallidas et al 2016]. Multiple serum and pleural biomarkers such as mesothelin, osteopontin and fibulin-3 have been investigated in MPE [Creaney et al 2014;Pass et al 2005Pass et al , 2012Porcel, 2013;Porcel et al 2004].…”

Advances in pleural disease

“…PSALLIDAS et al [6] provide a state-of-the-art review of malignant pleural effusion from bench-to-bedside focusing on the pathogenesis, novel treatments and future directions. BHATNAGAR et al [7] summarise the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, indwelling pleural catheters and pleural manometry.…”