Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy

Abstract

Malignant pleural effusions (MPE) have historically been associated with a poor prognosis, and patients often require a series of invasive procedures and hospitalizations that significantly reduce quality of life at the terminus of life. However, advances in the management of MPE have coincided with the era of immunotherapies, and to a lesser extent, antiangiogenic therapies for the treatment of lung cancer. Landmark studies have shown these drugs to improve overall survival and progression-free survival in patients with lung cancer, but a paucity of phase III trial data exists for the impact of immune checkpoint inhibitors (ICI) on lung cancers associated with MPE. This review will focus on the leading studies investigating the impact of ICI and antiangiogenic therapies in patients with lung cancer and MPE. The diagnostic and prognostic values of vascular endothelial growth factor and endostatin expression levels in malignancy will also be discussed. These advancements are changing the paradigm of MPE management from palliation to treatment for the first time since 1767 when MPE was first reported. The future holds the promise of durable response and extended survival in patients with MPE.

Case report: Envafolimab combined with Endostar in the treatment of advanced non-small cell lung cancer with malignant pleural effusion

“…Inhibitors that block VEGF activity are thought to effectively manage MPE ( 23 ). With the promise of ICIs in lung cancer and other malignancies, there has been a renewed interest in investigating the efficacy of local and systemic ICIs for patients with MPE ( 23 , 24 ). However, ICI monotherapy for the treatment of MPE is currently not recommended, possibly due to the increased mortality associated with MPE.…”

Immune checkpoint inhibitor plus chemotherapy as first-line treatment for non-small cell lung cancer with malignant pleural effusion: a retrospective multicenter study

“…It is well known that MPE has historically been associated with a grim prognosis. Previous studies have shown that the presence of MPE is related to reduced ICI efficacy, notably reduced OS [ 36 , 37 ]. In the era of immunotherapy and antiangiogenic therapy, future studies should focus on establishing a series of intrapleural therapies and systemic therapies to improve the OS of MPE patients.…”