Pleurodesis in malignant pleural effusions: a randomized study of tetracycline versus bleomycin

Abstract

Malignant pleural effusions are commonly managed with tube thoracostomy drainage followed by chemical pleurodesis. Both tetracycline and bleomycin have been shown to be effective for intrapleural instillation, although neither agent has definitively proved advantages over the other. The aim of the present study was to compare these two agents in terms of response rate and toxicity profile.A prospective, randomized trial was carried out in a single centre. Between May 1993 and January 1996, 62 evaluable patients with proved malignant pleural effusion were allocated to receive either intrapleural tetracycline (1.5 g) or bleomycin (60 mg) after the same drainage procedure. Demographic, clinical and fluid parameter data were comparable in both groups. Response was evaluated at 1, 3 and 6 months after pleurodesis.Mean survival and time to relapse did not differ between the two groups. No statistically significant differences were found in terms of efficacy at each evaluation time. Overall, 16 (52%) and 20 (64%) patients had a recurrence of pleural effusion during follow-up in the tetracycline and bleomycin arms, respectively. Fever was most common in bleomycin-treated patients (p=0.024) while pain was most frequent in the tetracycline arm (nonsignificant).Since no study agent was superior to the other in this trial, we suggest that economic costs, drug availability and medical skill should be considered in the choice of a sclerosing agent.

Malignant pleural effusion biomarkers as predictor for chemical pleurodesis success

“…Our study results conformed well to the previous result as clinical success occurred in 11 patients (73.3 3%) who received bleomycin, versus only 6 patients (40%) who took tetracycline. Moreover, treatment failure occurred more with the tetracycline group (9 patients, 60%); versus the bleomycin group (4 patients, 26.6%) [32,33] (see Fig. 1).…”

Management of malignant pleural effusions

“…Unlike doxycycline, bleomycin has been directly compared with tetracycline. Most of these studies demonstrated similar or higher success rates when utilizing bleomycin as a sclerosing agent, compared with tetracycline [117,128,129]. A direct study comparing doxycycline with bleomycin pleurodesis utilizing a small-bore catheter, demonstrated similar success rates (72% with bleomycin, 79% with doxycycline) [120].…”

“…As stated previously, direct studies comparing talc and bleomycin have demonstrated a superior pleurodesis success rate with talc [115,116,130]. An important criticism of bleomycin as a sclerosing agent involves its relative expense as compared with other sclerosing agents such as talc or doxycycline [129,131]. However, studies utilizing small-bore catheters and bleomycin have demonstrated successful pleurodesis [120,121] and therefore a potential overall cost saving when factors such as hospitalization, duration, and procedure costs are included.…”

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

“…3) [13][14][15][16][17][18][19][20][21], tetracycline (Fig. 4) [14,[22][23][24][25][26][27][28][29][30][31][32][33], bleomycin (Fig. 5) [34][35][36][37][38] and intrapleural chemotherapy and immunotherapy ( Fig.…”