Cisplatin and cytarabine administered intrapleurally as treatment of malignant pleural effusions

Eight patients with histologically-documented malignant pleural effusions received a total of ten courses of intrapleurally administered chemotherapy with cisplatin (100 mg/m2) and cytarabine (10(-2) M). Sodium thiosulfate was simultaneously administered intravenously to protect against cisplatin-induced nephrotoxicity. There was no local toxicity observed and the only significant systemic toxicity (bone marrow depression) developed in a patient with poor marrow reserve prior to the initiation of therapy. Six of seven evaluable patients exhibited major reductions (greater than 75%) in the size of their effusions lasting for 2 to 10 plus months (median: 4 months). We conclude that the intrapleural administration of this chemotherapy regimen results in objective and subjective improvement in patients with malignant pleural effusions with minimal local and systemic toxicity (except for cisplatin-induced emesis) and does not require chest tube drainage or prolonged hospitalization.