Effect of Chemotherapy on Removal of Indwelling Pleural Catheters in Breast Cancer Patients with Malignant Pleural Effusions

Abstract

Background: Indwelling pleural catheters (IPC) are commonly used in the management of malignant pleural effusions (MPE). The effect of systemic chemotherapy on IPC removal has not been reported previously. Objectives: The purpose of this study is to identify the effect of chemotherapy on the removal of IPCs in breast cancer patients with MPEs. Methods: In this retrospective cohort study at an academic tertiary-care center, patients with breast cancer and MPE who received an IPC between 2006 and 2016 were identified from a prospectively collected database. Patient chemotherapy data were obtained, as well estrogen receptor (ER) and human epidermal growth factor receptor-2 status at the time of diagnosis. Patients receiving chemotherapy while their IPC was in situ were compared to those who did not. The primary outcome was time to IPC removal. All patients were followed until IPC removal or death. Results: A total of 207 patients and 216 IPCs were included in the analysis. There was no difference in time to IPC removal between the chemotherapy and no-chemotherapy groups (HR 0.73, 95% CI 0.50–1.07, p = 0.10) or rate of IPC removal (OR 1.16, 95% CI 0.68–1.98, p = 0.59). The risk of IPC infection was not different between patients who received chemotherapy and those who did not (RR 0.57, 95% CI 0.06–5.39, p = 0.48). Conclusions: Treatment with chemotherapy with an IPC in situ was not associated with a reduced time to IPC removal in our breast cancer population. IPC insertion in patients receiving chemotherapy is safe and not associated with an increased risk of infection.

Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study

“…This low incidence of infection is consistent with prior literature demonstrating that IPCs are safe, including in patients receiving chemotherapy [46-48]. …”

The Optimal Management of Malignant Pleural Effusion: Steady Progress Towards an Evidence-Based Approach

“…Univariate analysis showed no difference in the primary outcome in the time to IPC removal between the chemotherapy and no chemotherapy groups, [11], and chemotherapy regime used (i.e., first, second or third line) similarly did not influence outcome. Moreover, there was no difference in time to IPC removal on after adjusting for age, performance status, trapped lung, cytology, HER2 status, ER status and history of chest radiation [11]. Importantly, IPC infection risk was not different between those who received chemotherapy and those who did not [11].…”

“…Moreover, there was no difference in time to IPC removal on after adjusting for age, performance status, trapped lung, cytology, HER2 status, ER status and history of chest radiation [11]. Importantly, IPC infection risk was not different between those who received chemotherapy and those who did not [11].…”

“…In the present edition of Respiration, Mitchell et al [11] specifically studied the effect of chemotherapy on the removal of IPCs in breast cancer patients with MPE. In their retrospective cohort study performed at an academic tertiary-care centre, a prospectively collected database spanning a decade was used identify cases where an IPC was inserted for MPE secondary to breast cancer.…”

“…Chemotherapy is known to prolong life in patients with metastatic breast cancer, and at least in theory, should reduce the tumour burden in the pleural space [12], yet the findings of Mitchell et al [11] suggest that chemotherapy had no impact on IPC removal (or death) at 60 days post IPC insertion. What are the practical implications of these findings?…”