Pleural effusion in lung cancer: more questions than answers

Lung cancer remains the most common fatal malignancy, despite more aggressive therapies. Few patients will survive 5 years, as up to 80% of the patients will present with advanced-stage disease at diagnosis. Chemotherapy offers little benefit in terms of median survival and disease-free survival in patients with advanced-stage non-small-cell lung carcinoma (NSCLC). In the last decade, the development of new targeted therapies based on the better understanding of different paths of carcinogenesis has given new hope to both physicians and patients. Metastatic pleural effusion from lung cancer has a particularly poor prognosis, and in NSCLC it is actually reclassified as stage IV disease. A possible explanation of this observation is differences in the genomics between primary tumors and metastasis, leading to possible different therapeutic approaches with novel molecular therapies in this patient population. The current review aims to summarize the actual situation of research in pleural disease due to lung carcinoma in relation to novel targeted therapies tested in this patient population.