Study Shows Catheter Superior to Talc for Management of Malignant Pleural Effusions

BUFFALO, NY - About half of all cancer patients with metastatic disease will develop malignant pleural effusions (MPE), which result in significant respiratory challenges and a poorer overall quality of life. A lack of research data has hampered physicians’ efforts to effectively manage MPE. But a recent Cancer and Leukemia Group B (CALGB) Phase III clinical study that compared two MPE management modalities found that indwelling small catheter drainage (SCD) provides much better palliation than talc slurry pleurodesis (TP), the most widely used approach in the United States.

Study co-leader Todd Demmy, MD, Associate Professor of Surgical Oncology and Clinical Chair, Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, will present the results at the 46^th annual meeting of the American Society of Clinical Oncology.

The study enrolled 58 patients (median age 63), all with symptomatic unilateral MPE, randomized to receive either TP or small catheter drainage (SCD). Within 30 days, the SCD group recorded fewer deaths or effusion recurrences (18%) than the TP group (47%). The overall technical success rate was higher for SCD (62%) than TP (45%). Those patients whose MPE were drained daily by an indwelling small catheter also experienced better overall lung function and improved quality of life.

“The results demonstrate that SCD has a better success rate than TP, the most commonly used therapy for MPE in the United States,” notes Dr. Demmy. He adds that TP may be associated with a higher death rate because of the inability of patients with advanced cancer to tolerate it. The study outcomes “support a lot of the concerns of doctors who feel that TP is too stressful for these patients,” he explains.

SCD also “works over a longer period of time, and is more likely to help people whose lungs are not immediately able to reinflate,” says Dr. Demmy. “Because it’s so hard to predict which patients will fall into that category, the catheter is probably much better, because it’s more likely to work as a first-line therapy.” And SCD offers an additional advantage: patients do not need to be hospitalized and can go home with the catheter in place.

Quality-of-life scales used in the study measured changes in shortness of breath, physical function, and symptoms.

“SCD provides better palliation to late-stage cancer patients who develop MPE, and should be considered as a frontline therapy,” says Dr. Demmy.

The study, CALGB 30102, was sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health, and is led by one of its Cooperative Clinical Trials Groups — the Cancer and Leukemia Group B.

The Cancer and Leukemia Group B (CALGB) is a national clinical research group sponsored by the National Cancer Institute, with the Central Office headquartered at the University of Chicago and Statistical Center located at Duke University. Founded in 1956, the CALGB brings together clinical oncologists and laboratory investigators to develop better treatments for cancer. CALGB has grown exponentially over the years into a national network of 26 university medical centers, more than 200 community hospitals and more than 3,000 oncology specialists who collaborate in clinical research studies. These studies aim to reduce morbidity and mortality from cancer, relate biological characteristics of cancer to clinical outcomes, and develop new strategies for the early detection and prevention of cancer. For more information, visit http://www.calgb.org

The mission of Roswell Park Comprehensive Cancer Center is to understand, prevent and cure cancer. Roswell Park, founded in 1898, was one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in Upstate New York. The Institute is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers; maintains affiliate sites; and is a partner in national and international collaborative programs. For more information, visit Roswell Park’s website at http://www.roswellpark.org, call 1-800-ROSWELL (1-800-767-9355) or email AskRoswell@Roswellpark.org.

Editor’s note: Dr. Demmy’s presentation, “Comparison of in-dwelling catheters and talc pleurodesis in the management of malignant pleural effusions,” will be included in two separate poster discussion sessions on the Patient and Survivor Care track at the 2010 annual meeting of the American Society of Clinical Oncology at McCormick Place, Chicago, IL on Tuesday, June 8, 2010 from 8 am to noon in Room E450a and 11 am to noon in Room E353.