Malignant pleural effusion (MPE) is a common complication of advanced
non-small cell lung cancer (NSCLC).
Bevacizumab, a humanized
monoclonal antibody against
vascular endothelial growth factor (
VEGF), has been shown to be efficient in suppressing the accumulation of pleural fluid. However, whether intrapleural delivery of
bevacizumab can be used to treat MPE remains unknown. The aim of the present study was to evaluate the efficacy and safety of combined intrapleural
therapy with
bevacizumab and
cisplatin, an
antineoplastic agent, in controlling MPE. A total of 72 NSCLC study subjects with MPE were randomly assigned to one of two groups. The first group received intrapleural
bevacizumab (300 mg) with
cisplatin (30 mg)
therapy and the second group received intrapleural
cisplatin (30 mg)
therapy alone. Pleural fluid was collected from both groups prior to and following treatment. The levels of
VEGF and
carcinoembryonic antigen (CEA) in the pleural fluid were determined by ELISA. In 70 evaluable study subjects, the curative efficacy in the
bevacizumab group was significantly higher than that found in the
cisplatin group (83.33 vs. 50.00%, respectively; p<0.05).
Therapy with combined
bevacizumab plus
cisplatin significantly reduced
VEGF levels in the pleural fluid (p<0.01). In the
bevacizumab group, the levels of
VEGF in the pleural fluid were significantly lower compared to those of the
cisplatin group
after treatment, which showed greater efficacy (p<0.01). In addition, combination
therapy showed greater efficacy in the patients with high levels of
VEGF expression (p<0.01). There was no significant difference in grade III/IV adverse events between the two groups. All procedures were well tolerated by the patients. Combined intrapleural
therapy with
bevacizumab and
cisplatin was effective and safe in managing NSCLC-mediated MPE. We propose that
VEGF expression levels in MPE could serve as a prognostic marker for
bevacizumab therapy.