The most used standard
therapy for
malignant pleural effusion(MPE)is tube
thoracostomy drainage, except in cases where there are few
pleural effusions or no symptoms. It has been reported that instilling an intrapleural agent is necessary for producing
pleurodesis after tube
thoracostomy drainage. To date, numerous chemical agents for the treatment of MPE have been studied. These include
antibiotics, antineoplastic agents,
biological response modifiers and others, that showed various degrees of chemical
sclerosis. It was entered on a randomized comparison of
tetracycline and
bleomycin for treatment of MPE. The rate and time to recurrence were both significantly greater with
bleomycin. In comparison,
Talc was superior to
bleomycin for control of MPE. Therefore, thoracoscopic
pleurodesis with
talc is now considered to be the gold standard treatment for MPE. However,
talc has not been commercially available in Japan. We sought to evaluate the efficacy and toxicity of three intrapleural
therapy regimens consisting of
bleomycin,
OK-432 or
cisplatin plus
etoposide(PE), for the management of
malignant pleural effusion in previously untreated
non-small cell lung cancer. The primary endpoint, pleural progression-free survival did not differ significantly between groups. Intrapleural treatment using
OK-432 in the management of MPE was selected because it had the highest 4-week pleural progression-free survival rate and toxicity was tolerable. At present,
OK- 432 is the standard agent used in Japan.