Can EGFR-Tyrosine Kinase Inhibitors (TKI) alone without talc pleurodesis prevent recurrence of malignant pleural effusion BENTHAM (MPE) in lung adenocarcinoma

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

Research output: Contribution to journalArticlepeer-review

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 ofpatients 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 ofpositive EGFR mutation status.

Original languageEnglish (US)
Pages (from-to)68-76
Number of pages9
JournalCurrent Drug Discovery Technologies
Volume13
Issue number2
DOIs
StatePublished - Aug 1 2016

Keywords

  • Adenocarcinoma
  • Epidermal growth factor receptor tyrosine kinase inhibitors
  • Lung cancer
  • Pleural effusion
  • Pleurodesis

ASJC Scopus subject areas

  • Drug Discovery

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