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Outpatient talc for malignant pleural effusion

Takeaway

  • Outpatient administration of talc through indwelling pleural catheter (IPCs) for treatment of malignant pleural effusion increased odds of pleurodesis at 35 days compared to indwelling catheter alone.

Why this matters

  • Used in isolation, indwelling pleural catheters have been shown to be as good as traditional approaches but they do not confer the same likelihood of pleurodesis.
  • A previous noncomparative series involving 22 patients has suggested that administration of talc through an indwelling pleural catheter can achieve high rates of pleurodesis.

Key results

  • 43% in the talc group had successful pleurodesis by day 35 vs 23% in the placebo group (HR 2.20; 95% CI 1.23-3.92; P=.008).
  • Rate of successful pleurodesis at day 70 was 51% in the talc group vs 27% in the placebo group (HR 2.24; 95% CI 1.31-3.85; P=.003).
  • Assessment of pleurodesis according to total volume of fluid drained over 2 wks talc over placebo at day 35 (HR 3.78; 95% CI 1.81-7.90; P<.001) and day 70 (HR 3.43; 95% CI 1.74-6.75; P<.001).
  • 7% in the talc group underwent an additional therapeutic procedure for fluid management vs 3% of controls (odds ratio [OR] 2.69; 95% CI 0.50-14.34; P=.25).
  • No significant difference was seen in the number of participants who had adverse events.
  • Blockage of the indwelling pleural catheter occurred in 6% of the talc group and 4% of the placebo group.

Study design

  • Randomised, placebo-controlled, single-blind, parallel-group (IPC-Plus) trial of 154 patients with malignant pleural effusion recruited from 18 UK centres.
  • Patients were randomly assigned to receive either 4g of talc slurry or placebo through an indwelling pleural catheter on an outpatient basis.
  • Funding: Becton Dickinson.

Limitations

  • Follow-up of just 70 days.
  • High numbers of patients excluded before randomisation.
  • Did not formally assess true degree of visceroparietal adhesion.


References


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