[Locoregional therapy in patients with malignant pleural effusion--two different types of "BAC therapy"]

We used fibrin clot (FC) as a carrier of anticancer drug (AD) to provide a novel therapy for patients with serious malignant pleural effusion. After evacuating the pleural fluid, we enhanced an "FC-AD" formation in the pleural cavity of the patient to prevent this kind of effusion from reaccumulating. In an attempt to enhance FC-AD formation, we used two different procedures; either, fibrinogen/AD/G.T.XIII (procedure I) or fibrin glue/AD (procedure II). G.T.XIII is our newly devised compound drug, composed of biodegradable gelatin (G), thrombin (T) and a blood coagulation factor XIII (XIII). This therapy was termed "Bio-Adhesio-Chemo (BAC) therapy." We conducted BAC therapy 52 times on 44 patients using procedure I and 4 times on 4 patients using procedure II. Complete remission of the effusion was obtained, overall, in 83%, partial remission in 17%, and no non-effective case. The improvement of PS of the patients treated was 73%. Nineteen patients could be discharged with this therapy. Toxic effects with BAC therapy were within Grade 2 in all cases. We could favorably enhance FC-AD formation, in every case, by both procedure I and II. BAC therapy is very promising as a novel cancer chemopleurodesis for patients with malignant pleural effusion.