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Intrapleural Administration With Rh-Endostatin and Chemical Irritants in the Control of Malignant Pleural Effusion: A
Cheng-Qiong Wang1,2, Xiao-Rong Huang3, Min He4
1Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Introduction:
A modified and recombinant human endostatin (Rh-endostatin) is often used in the control of malignant pleural effusion (MPE) through intrapleural infusion.
Objectives:
To demonstrate the clinical response, survival, and safety of Rh-endostatin plus chemical irritants, their optimal combinations, treatment threshold, and optimal usage, we performed a new systematic review and meta-analysis.
Methodology:
All randomized controlled trials (RCTs) were collected from Chinese and English electronic databases (from inception until August 2020). We pooled the data using a series of meta-analyses and summarized the evidence quality following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results:
We included 75 RCTs recruiting 4,678 patients, which reported six combinations for Rh-endostatin plus chemical irritants. Among the six combinations, only Rh-endostatin plus cisplatin (DDP) with enough trials might improve the complete response [2.29 (1.93, 2.71)] and quality of life [3.01 (2.49, 3.63)] and reduce treatment failure [0.29 (0.25, 0.33)] and progressive disease [0.27 (0.22, 0.34)]. It might not increase the risk of adverse drug reactions. For patients with lung cancer, moderate to massive effusion, initial treatment, Karnofsky Performance Status (KPS) score ≥60, or anticipated survival time ≥3 months, Rh-endostatin (30-45 mg each time, once or twice a week 3-4 times) plus DDP (30-60 mg/m2) obtained a significant improvement in clinical response and a reduction of failure and progressive disease. Most results had good robustness and moderate quality.
Conclusions:
Current evidence suggests that Rh-endostatin with DDP may be an optimal combination, which may improve clinical response and reduce failure and progressive disease with good safety. Rh-endostatin (30-40 mg each time, once or twice a week 3-4 times) with DDP (30-40 mg/m2) may be an optimal usage for achieving an ideal response.
Insights
Recombinant human endostatin (Rh-endostatin) combined with cisplatin (DDP) shows improved clinical response and reduced disease progression in malignant pleural effusion. This combination offers a safe and effective treatment option for eligible patients.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Malignant pleural effusion (MPE) is a common complication of various cancers.
- Intrapleural infusion of recombinant human endostatin (Rh-endostatin) is a recognized treatment for MPE.
- Optimizing Rh-endostatin combination therapy requires further investigation into efficacy and safety.
Approach:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Data from 75 RCTs involving 4,678 patients were pooled and analyzed.
- Evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Key Points:
- Rh-endostatin combined with cisplatin (DDP) demonstrated significant improvements in complete response rates and quality of life.
- This combination effectively reduced treatment failure and progressive disease compared to other regimens.
- Optimal patient selection includes those with lung cancer, moderate to massive effusion, and good performance status (KPS ≥60).
Conclusions:
- Rh-endostatin plus DDP represents a promising and safe combination therapy for managing MPE.
- Specific dosage and frequency guidelines (Rh-endostatin 30-40 mg/week, DDP 30-40 mg/m²) are proposed for optimal outcomes.
- The findings support Rh-endostatin and DDP as a valuable treatment strategy for improving patient response and survival.
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