Malignant Pleural Effusion and Its Current Management: A Review

Area of Science:

• Oncology
• Pulmonology
• Pathophysiology

Background:

• Malignant pleural effusion (MPE) is a common complication in advanced cancers, affecting up to 15% of patients.
• MPE is frequently associated with lung cancer, breast cancer, lymphoma, gynecological malignancies, and mesothelioma.
• Tumor-host cell interactions and specific gene mutations are increasingly recognized as key in MPE pathogenesis.

Purpose of the Study:

• To review the latest findings on the pathophysiological mechanisms of MPE.
• To analyze recently updated clinical practice guidelines for MPE management.
• To synthesize novel insights into MPE dynamics, prognosis, and treatment.

Main Methods:

• Literature review of over 70 articles from PubMed and Medline, focusing on recent publications.
• Analysis of recently published (within the last seven years) clinical practice guidelines.
• Synthesis of information on molecular factors, mutations, and pathophysiological mechanisms.

Main Results:

• Activating mutations in genes such as EGFR, KRAS, PIK3CA, BRAF, MET, EML4/ALK, and RET correlate with increased MPE incidence.
• Updated guidelines emphasize a patient-centric approach, incorporating scoring systems, out-of-hospital care, and ultrasound.
• Novel validated prediction tools in current guidelines show potential for improving patient outcomes.

Conclusions:

• MPE remains a significant challenge in advanced malignancy, with molecular factors playing a crucial role in disease dynamics and prognosis.
• Recent guidelines offer advancements in patient management, including validated prediction tools and a focus on patient-centered care.
• Further research is needed on the clinical utility of biomarkers, novel treatment modalities, and management of specific MPE scenarios.