Improving treatment of malignant pleural effusion
Malignant pleural effusion (MPE) is a collection of cancerous fluid around the lung. MPE is common, affecting 750,000 people across Europe and the US each year. It causes severe breathlessness and poor quality of life, and can often come back. Average survival from diagnosis is only 4-6 months, with a lot of variation between patients. Most require pleurodesis (sealing the cavities around the lung) to prevent it coming back, typically with talcum powder. This usually requires a long hospital stay and isn't suitable for many patients.
What translational research was done?
Our Cochrane analysis of results across trials showed the need for better treatment options and the importance of patient choice. With our patient involvement group, we highlighted the need to improve early prediction of a patient’s outcomes to guide treatment decisions, and better ways to achieve pleurodesis without a hospital stay.
Combining data from our own and international cohorts, we developed and validated the first scoring system (LENT) to predict death in those with MPE.
Our three pilot studies explored the best way to deliver pleurodesis to outpatients. The SEAL-MPE trial of an internal long-term pleural catheter that slowly releases medication (IPC) suggested it was safe, with rapid, effective pleurodesis.
We also evaluated an implantable pleural-bladder pump for outpatients. This was effective but wasn’t very acceptable to patients and the tubing could get blocked.
Lastly, we evaluated inserting a standard IPC as a day case, followed by talc pleurodesis via the IPC as an outpatient option. This was successful and well-tolerated.
Translation into later phase research, clinical practice and patient benefit
Our LENT score is used internationally and has been incorporated into national guidelines helping clinicians and patients make complex treatment decisions. Data from SEAL-MPE led to the device being provisionally approved by the FDA. An international randomized trial (SWIFT) rolled it out further. However, results were disappointing, with the catheter causing complications. It is being adapted to avoid tube blockages ahead of further studies.
Following our talc-via-IPC research, we designed and conducted the IPC-Plus trial, a UK multicentre, placebo-controlled randomized study. This treatment was safe and effective, and defined a new outpatient option for MPE. It has been incorporated into guidelines and offered to patients in the UK and internationally.