Timing of definitive pleural intervention within systemic anticancer therapy in malignant pleural effusion from...

Malignant pleural effusion (MPE) is a common and serious complication of advanced lung cancer. Although guidelines recommend early definitive intervention, the optimal timing of talc pleurodesis-based definitive intervention in pharmacologically sensitive tumors remains undefined. This study aimed to evaluate whether early pleural intervention (EPI) is associated with MPE control and clinical outcomes in lung cancers with high-response systemic therapies, and to define a clinically meaningful time threshold for EPI.

We conducted a retrospective, single-center, cohort study using the pharmacy database of a tertiary hospital between 2012 and 2024. We screened consecutive patients with EGFR/ALK/ROS1-rearranged non-small cell lung cancer or small-cell lung cancer diagnosed with MPE while receiving systemic anticancer therapy (SACT). Demographics, disease characteristics, treatment patterns, pleural effusion (PE) control and overall survival (OS) were analyzed. EPI was defined as definitive pleural intervention (talc poudrage or talc slurry pleurodesis) performed within 30 days of MPE detection. Primary endpoint was PE control stratified by the use of EPI. Logistic and Cox regression models were used to identify predictors of PE control and OS.

A total of 392 patients were screened, 83 patients met eligibility criteria (19 underwent EPI and 64 non-EPI). PE control was significantly achieved in the EPI group (94.7% vs. 59%, P=0.004). EPI was independently associated with PE control [odds ratio (OR) =37.3, 95% confidence interval (CI): 3.35-413.8; P=0.003] and longer OS [median OS 25.4 vs. 11.8 months; hazard ratio (HR) =0.46, 95% CI: 0.22-0.95; P=0.04].

In this retrospective, single-center cohort study, EPI integrated within a multidisciplinary care was associated with higher rate of short-term MPE control and longer survival in MPE from high-response lung cancers. However, given the retrospective design and the limited cohort size, definitive conclusions cannot be drawn from these findings. Nevertheless, the results suggest that the timing of definitive pleural intervention may play an important role in prognostic outcomes. Prospective studies are warranted to provide more conclusive answers to this important question.