Can EGFR-Tyrosine Kinase Inhibitors (TKI) Alone Without Talc Pleurodesis Prevent Recurrence of Malignant Pleural Effusion (MPE) in Lung Adenocarcinoma

Author(s): Akash Verma, Akhil Chopra, Yeo W. Lee, Lavina D. Bharwani, Atasha B. Asmat, Dokeu B.A Aneez, Fazuludeen A. Akbar, Albert Y.H. Lim, Sanjay H. Chotirmall, John Abisheganaden.

Journal Name: Current Drug Discovery Technologies

Volume 13 , Issue 2 , 2016

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Abstract:

Background and objective: Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) are effective against lung adenocarcinoma. However, limited data is available assessing the effectiveness of EGFR-TKI use in preventing re-accumulation of MPE. To our knowledge, there is no literature on comparison of talc pleurodesis with EGFR-TKIs alone on re-accumulation of MPE in Asian population. We investigated if EGFR-TKI therapy for advanced lung adenocarcinoma with malignant pleural effusion (MPE) is also successful in preventing pleural fluid re-accumulation following initial drainage.

Methods: An observational cohort study of patients with lung adenocarcinoma and MPE in the year 2012 was conducted.

Results: 70 patients presented with MPE from lung adenocarcinoma. Fifty six underwent EGFR mutation testing of which 39 (69.6%) had activating EGFR mutation and 34 (87.1%) received TKI. 20 were managed by pleural fluid drainage only whereas 14 underwent talc pleurodesis following pleural fluid drainage. Time taken for the pleural effusion to re-accumulate in those with and without pleurodesis was 9.9 vs. 11.7 months, p=0.59 respectively. More patients (n=10, 25.6%) with activating EGFR mutation presented with complete opacification (white-out) of the hemithorax compared to none without activating EGFR mutation (p=0.02).

Conclusion: In TKI eligible patients, early talc pleurodesis may not confer additional benefit in preventing re-accumulation of pleural effusion and may be reserved for non-adenocarcinoma histology, or EGFR negative adenocarcinoma. Complete opacification of the hemithorax on presentation may serve as an early radiographic signal of positive EGFR mutation status.

Keywords: Lung cancer, adenocarcinoma, pleural effusion, pleurodesis, epidermal growth factor receptor tyrosine kinase inhibitors.

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Article Details

VOLUME: 13
ISSUE: 2
Year: 2016
Page: [68 - 76]
Pages: 9
DOI: 10.2174/1570163813666160524142846

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