Risk Factors for and Time to Recurrence of Symptomatic Malignant Pleural Effusion in Patients With Metastatic Non-Small Cell Lung Cancer with EGFR or ALK Mutations

Schwalk AJ et al.

Chest Volume 159, Issue 3, March 2021, Pages 1256-1264

What is the key question?

  • Do patients with metastatic Non-Small Cell Lung Cancer (NSCLC) and actionable mutations benefit from a similar definitive management approach of their malignant pleural effusions (MPE) compared to patients without such mutations?

What is the bottom line?

  • Because their disease is expected to respond quickly and markedly to targeted therapy, patient with NSCLC and actionable mutations are less likely than those without actionable mutations to receive definitive MPE management.
  • This study is a retrospective cohort study of 396 consecutive patients who underwent initial thoracentesis for MPE where 101 (25.5%) had actionable mutations while 295 (74.5%) did not. Most patients with actionable mutations (90%) were receiving targeted treatment within 30 days of initial thoracentesis. On multivariate analysis, the study found no difference in the hazard of MPE recurrence between the two groups
  • Larger pleural effusion size on chest radiography (P < 0.001), higher pleural fluid lactate dehydrogenase (P < 0.001), and positive cytologic examination results (P = 0.008) were associated with an increased hazard of recurrence.

Why read on?

  • This study suggests that targeted therapy alone is not sufficient for managing MPEs in patients with metastatic NSCLC and actionable mutations. This category of patients would benefit from the same definitive MPE management approach offered to patients without actionable mutations.