Novel therapies for malignant pleural effusion: Anti‑angiogenic therapy and immunotherapy (Review)

Abstract

Patients with a variety of malignancies can develop malignant pleural effusion (MPE). MPE can cause significant symptoms and result in a marked decrease in quality of life and a poor prognosis. MPE is primarily considered as an immune and vascular manifestation of pleural metastases. In the present review, the existing evidence supporting the applicability of anti-angiogenic therapy and immunotherapy for the treatment of MPE was summarized. Patients with MPE have benefited from anti-angiogenic agents, including bevacizumab and endostar; however, no relevant prospective phase III trial has, thus far, specifically analyzed the benefit of anti-angiogenic therapy in MPE. Immunotherapy for MPE may be sufficient to turn a dire clinical situation into a therapeutic advantage. Similar to anti-angiogenic therapy, more clinical data on the efficiency and safety of immunotherapy for controlling MPE are urgently required. The combined use of anti-angiogenic therapy and immunotherapy may be a promising strategy for MPE, which requires to be further understood. Contents1. Introduction 2. Anti-angiogenic treatment for malignant pleural effusion (MPE) 3. Immunotherapy for MPE 4. Conclusion and future research direction

Aptamer-siRNA chimera and gold nanoparticle modified collagen membrane for the treatment of malignant pleural effusion

“…Li et al recommended that nanomedicine should be desired to improve not only the safety but also the efficacy of immunotherapy ( Li and Kataoka, 2021 ). For malignant pleural effusion, tumors and inflammation that stimulate pleural thickening and fibrosis, PD-1 inhibitors are difficult to enter the pleural cavity from peripheral blood and accumulate in sufficient drug concentrations ( He D. et al, 2021 ). Our results showed that intrapleural administration of PD-1 inhibitors rapidly activated T cells and had a high anti-tumor effect in the short term.…”

“…A large number of lymphocytes enter the pleural cavity during the formation of pleural effusion; however, their anti-tumor immune activity is significantly reduced. Activating these lymphocytes in vitro can significantly enhance their tumor killing ability and effectively alleviate the occurrence of malignant pleural effusion ( He D. et al, 2021 ). Tumors and inflammation can stimulate pleural thickening and fibrosis, and systemic drugs are difficult to accumulate in the pleural cavity at concentrations that can effectively kill cancer cells.…”

Efficacy of Endostatin Combined with EGFR-TKIs in the Treatment of Malignant Pleural Effusion in EGFR-positive Advanced Lung Adenocarcinoma

“…In the absence of oxygen, HIF-1α can make VEGFmRNA more stable, increase the transcription level of VEGF receptors, and produce a large number of new blood vessels [9]. The action of VEGF is primarily mediated by endothelial cell receptors VEGFR-1 and VEGFR-2 [10]. VEGF binds to its receptors and induces downstream signaling such as PKC and MAPK, a process that induces vascular endothelial cell differentiation and proliferation, thereby promoting cancer growth and MPE production [11].…”

Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy

“…Thus, human endostatin was engineered and modified with a nine-amino acid sequence at the Nterminal to improve solubility and stability and is currently available under the brand name Endostar. 3,66 In 2014, Zhao et al conducted an RCT evaluating the clinical efficacy and safety of intrapleural Endostar when added to cisplatin/pemetrexed chemotherapy compared with standard regimen of cisplatin/pemetrexed for patients with MPE due to nonsquamous NSCLC. 67 The treatment outcomes were defined according to the World Health Organization guidelines: CR, PR, NC, and progressive disease.…”