Review Article

Malignant Pleural Effusion: Diagnosis and Management

Table 2

Main trials investigating management of malignant pleural effusion.

Authors and referencesYear of publicationComparatorCommentary

Davies et al. [11] (TIME2)2012IPC versus talc pleurodesisNo significant differences between the two groups to relieve dyspnea
Rahman et al. [12] (TIME1)2015Use of nonsteroidal anti-inflammatory drugs (NSAID) and chest drain sizeNSAID versus opiates was associated with more need for rescue medication in the first with no lower rates of pleurodesis efficacy. The 12 F versus 24 F chest tubes were associated with pain reduction but did not meet the noninferiority criteria for the efficacy of pleurodesis.
Thomas et al. [54] (AMPLE)2017IPC versus talc pleurodesisMedian hospitalization days was lower in IPC patients ()
Wahidi et al. [82] (ASAP)2017IPC: Daily drainage versus symptom-guided drainageHigher success rate of pleurodesis with aggressive drainage, without improving control of dyspnea
Muruganandan et al. [81] (AMPLE2)2018IPC: Daily drainage versus symptom-guided drainageHigher success rate of pleurodesis with aggressive drainage, without improving control of dyspnea
Bhatnagar et al. [92] (IPC plus)2018Talc pleurodesis through IPC versus placeboPleurodesis in 43% and 23%, respectively ()
Mishra et al. [96] (TIME3)2018Intrapleural urokinase versus placeboUrokinase does not reduce dyspnea or improve pleurodesis success rate
Bhatnagar et al. [64] (TAPPS)2019Talc poudrage by thoracoscopy versus talc slurry by chest drainagePleurodesis failure rate of 22% in the first group and 24% in the second ()
Sivakumar et al. [98] (OPTIMUM)Talc pleurodesis through IPC versus chest drainage (small size)Improving the quality of life will be assessed
ClinicalTrials.gov identifier: NCT02649894 [99] (SWIFT)Silver nitrate eluting catheter versus standard IPCThe success rate of pleurodesis will be assessed
Anzctr.org.au identifier: ACTRN12618001013257 [100] (AMPLE3)IPC versus VATS pleurodesisRequirement for ipsilateral pleural procedure
Matthews et al. [101] (MESOTRAP)VATS-PD versus standard IPCImprovement of dyspnea will be assess in patients with trapped lung and malignant pleural mesothelioma

Unpublished results; VATS, video-assisted thoracoscopy surgery; VATS-PD, video-assisted thoracoscopic partial pleurectomy or decortication.