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Effect of chemotherapy, immunotherapy, and targeted therapies on removal of indwelling pleural catheters in non-small cell lung cancer patients with malignant pleural effusions

Published:December 19, 2022DOI:https://doi.org/10.1016/j.rmed.2022.107093

      Highlights

      • Malignant pleural effusions occur in ∼40% of patients with advanced NSCLC.
      • Malignant pleural effusions are often managed with indwelling pleural catheters.
      • Lower ECOG is associated with increased rate of pleurodesis.
      • EGFR targeted therapy is associated with higher rates of and earlier pleurodesis.

      Abstract

      Background

      Indwelling pleural catheters (IPCs) are a mainstay therapy for malignant pleural effusions (MPEs). Many patients treated with IPCs achieve pleurodesis. We aimed to identify the effect of systemic therapies for non-small cell lung cancer (NSCLC) on IPC removal in patients with associated MPEs.

      Methods

      We completed a retrospective cohort study of adult IPC recipients with metastatic NSCLC at the pleural effusion clinic at the Royal Alexandra Hospital from 2009 to 2020. We used logistic regression to assess the rates of IPC removal and Cox regression to assess the time to IPC removal.

      Results

      232 patients met inclusion criteria with 248 IPCs reviewed. The overall pleurodesis rate was 42.7% with a median time to pleurodesis of 68 (IQR 38–140) days. In univariate analysis, chemotherapy (OR 1.86, CI 0.99–3.49) and epidermal growth factor receptor (EGFR) targeted therapy (OR 3.81, CI 1.86–7.79) were associated with higher rates of pleurodesis. In multivariate analysis, increased rates of pleurodesis were associated with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of ≤2 (OR 4.82, CI 2.24–10.37) and EGFR targeted therapy (OR 3.87, CI 1.80–8.32). Earlier IPC removal was associated with EGFR targeted therapy in both univariate (HR 1.84, CI 1.20–2.83) and multivariate analysis (HR 1.86, CI 1.19–2.92).

      Conclusions

      Treatment with EGFR targeted therapy is associated with increased rates and earlier removal of IPC in patients with NSCLC in our cohort. Further large cohort studies are required to determine if this relationship persists.

      Keywords

      Abbreviations:

      MPE (malignant pleural effusion), IPC (indwelling pleural catheter), NSCLC (non-small cell lung cancer), EGFR (epidermal growth factor receptor), ECOG PS (Eastern Cooperative Oncology Group Performance Status)
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