Surreal illustration symbolizing personalized treatment for malignant pleural effusion.

Malignant Pleural Effusions: Are We Treating All Patients the Same?

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"A closer look at how personalized approaches could improve outcomes in malignant pleural effusion management."

Malignant pleural effusions (MPEs), the accumulation of fluid in the space between the lung and the chest wall due to cancer, pose a significant challenge in oncology. While numerous trials have aimed to optimize their management, a critical question remains: Are we truly addressing the diverse needs of all patients with MPEs?

The current landscape often involves pitting talc pleurodesis (a procedure that aims to fuse the lung to the chest wall, preventing further fluid accumulation) against tunneled indwelling pleural catheters (which allow for regular drainage of fluid). While studies like the AMPLE trial have provided valuable insights, they also highlight the complexities of MPE management.

This article delves into a recent discussion in The Journal of Thoracic and Cardiovascular Surgery (JTCVS), emphasizing the importance of recognizing the heterogeneity of MPEs and tailoring treatment strategies accordingly. We'll explore how a more nuanced approach, supported by detailed prospective registries, can pave the way for improved patient outcomes.

The Problem with 'One-Size-Fits-All' in MPE Treatment

Surreal illustration symbolizing personalized treatment for malignant pleural effusion.

Dr. Demmy raises a critical point: not all MPEs are created equal. By grouping together various malignancies and degrees of trapped lung (where the lung is unable to fully expand), we risk diluting the effectiveness of clinical trials and overlooking therapeutic nuances. This "clumping" effect may explain why some trials fail to detect significant differences between treatment arms.

One major issue is the exclusion or underrepresentation of patients with trapped lung in these trials. The perception that entrapment impairs pleurodesis can lead to a bias in patient selection, neglecting the opportunity to study or control for crucial variables like pleural elasticity. This highlights the need for more inclusive and carefully designed studies.

Quantifiable Pleural Elasticity: Assessing and incorporating this variable into study designs.
Cost of Disposables: Analyzing the economic impact of different treatment options.
Patient Compliance: Understanding and addressing factors that influence patient adherence to treatment protocols.
Newer Catheters and Pleurodesis Protocols: Evaluating the effectiveness of innovative approaches.
Catheter-Related Loculations: Managing complications associated with indwelling pleural catheters.

An interesting approach combines talc with indwelling catheters. Bhatnagar and colleagues demonstrated that outpatient administration of talc via an indwelling pleural catheter in patients without significant trapped lung resulted in improved pleurodesis at 35 days. The addition of talc roughly doubled the pleurodesis rate and resulted in significantly improved quality of life scores, without increasing adverse events.

Moving Towards Personalized MPE Management

The management of MPEs requires a shift from a generalized approach to a more individualized strategy. This means carefully considering the specific characteristics of each patient's condition, including the type of malignancy, the degree of lung entrapment, and other relevant factors.

Dr. Demmy's call for a new detailed prospective registry is crucial. Such a registry would allow for the collection of comprehensive data on MPE patients, facilitating a better understanding of the factors that influence treatment outcomes and enabling the development of more targeted therapies.

By embracing a personalized approach and supporting robust research efforts, we can move closer to optimizing the management of MPEs and improving the lives of patients affected by this challenging condition. The devil is in the details, and it’s time to design more meaningful trials that reflect the complexity of this disease.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jtcvs.2018.06.078, Alternate LINK

Title: Not All Malignant Pleural Effusions Are Created Equal

Subject: Cardiology and Cardiovascular Medicine

Journal: The Journal of Thoracic and Cardiovascular Surgery

Publisher: Elsevier BV

Authors: Jeffrey Javidfar

Published: 2018-09-01

Everything You Need To Know

What exactly are Malignant Pleural Effusions (MPEs)?

Malignant Pleural Effusions (MPEs) are the accumulation of fluid in the space between the lung and the chest wall due to cancer. This condition presents a significant challenge in oncology because it can cause symptoms such as shortness of breath and chest pain. The fluid buildup can compress the lung, making it difficult to breathe. Understanding the nature of MPEs is essential for effective treatment planning.

What are the primary treatments for MPEs discussed?

The primary treatments discussed are talc pleurodesis and tunneled indwelling pleural catheters. Talc pleurodesis involves introducing talc into the pleural space to fuse the lung to the chest wall, preventing fluid accumulation. Tunneled indwelling pleural catheters allow for regular drainage of the fluid. The choice between these treatments, as highlighted, should ideally be personalized based on factors like the degree of lung entrapment.

What is lung entrapment, and why is it important?

Lung entrapment refers to the lung's inability to fully expand, a factor that influences treatment outcomes. Its impact is particularly relevant in deciding on the best approach for managing MPEs. When the lung is trapped, talc pleurodesis may be less effective. Trials often exclude or underrepresent patients with trapped lung, potentially skewing results and making it difficult to determine the true efficacy of treatments like talc pleurodesis in various patient groups.

What is personalized MPE management, and why is it important?

Personalized MPE management emphasizes tailoring treatment strategies to the individual patient. This involves considering factors such as the type of malignancy, the degree of lung entrapment, and other patient-specific variables. This contrasts with the 'one-size-fits-all' approach, which may not account for the heterogeneity of MPEs. A personalized approach could improve outcomes because it considers the specific characteristics of each patient's condition, potentially leading to more effective treatments and improved quality of life.

Why are detailed prospective registries important in the context of MPE management?

The article highlights the importance of detailed prospective registries in improving MPE management. These registries collect comprehensive data on patient characteristics, treatment approaches, and outcomes. By analyzing this data, researchers can gain valuable insights into the effectiveness of different treatments, the impact of lung entrapment, and other factors influencing patient outcomes. The data gathered can support evidence-based decision-making, leading to more effective and personalized treatment strategies for MPEs.