Re-evaluating breast malignant pleural effusion: toward evidence-based, precision-aligned care with organoids

Area of Science:

• Oncology
• Translational Medicine
• Pleural Disease

Background:

• Malignant pleural effusion (MPE) in breast cancer is a common, debilitating complication of advanced disease.
• Current treatments like indwelling pleural catheters and chemical pleurodesis offer only temporary relief without addressing tumor biology.
• There is a need for advanced therapeutic strategies that target the underlying mechanisms of MPE.

Purpose of the Study:

• To propose a novel approach integrating patient-derived organoid modeling and next-generation sequencing for breast cancer MPE.
• To shift MPE management from palliative care to precision intervention by understanding tumor biology.
• To identify rational, localized combination therapies for improved local control and survival.

Main Methods:

• Utilizing patient-derived organoid models of pleural tumor cells.
• Characterizing organoids using next-generation sequencing for genomic profiling.
• Performing ex vivo drug testing on organoids with intrapleural agents, immune modulators, and bispecific antibodies.

Main Results:

• Organoid drug testing allows for ex vivo evaluation of local therapeutic agents.
• Genomic profiling can identify actionable resistance pathways specific to pleural metastases.
• This integrated approach facilitates the identification of personalized combination therapies.

Conclusions:

• Integrating organoid modeling and genomic profiling offers a framework for precision intervention in breast cancer MPE.
• This approach can identify localized, mechanism-driven therapies to improve effusion control and patient survival.
• Redefines breast cancer MPE as a treatable condition amenable to patient-tailored therapeutic strategies.