EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy

Abstract

Abstract. The aim of the present study was to evaluate the therapeutic effects and adverse reactions of Tarceva treatment for malignant pleural effusion (MPE) caused by metastatic lung adenocarcinomas. One hundred and twenty-eight patients who failed first-line chemotherapy drug treatment were divided into a mutation and a non-mutation group according to the presence or absence of epidermal growth factor receptor (EGFR) mutations. Each patient received closed drainage combined with simple negative pressure suction after thoracoscopic talc poudrage pleurodesis and oral Tarceva treatment. Short-term and long-term clinical therapeutic effects of Tarceva were evaluated. The EGFR mutation rate in pleural metastatic tissues of lung adenocarcinoma acquired through video-assisted thoracoscopic surgery was higher compared to that in surgical resection specimens, plasma specimens and pleural effusion specimens compared to previously reported results. There were significant statistical differences in the average extubation time (p<0.01), drainage volume of pleural effusion (p<0.05), Karnofsky score and formation of encapsulated pleural effusion 4 weeks after surgery (p<0.05) between these two groups. The number of patients with mild pleural hypertrophy in the mutation group was significantly higher compared to the non-mutation group (p<0.01), while the number of patients with severe pleural hypertrophy was significantly reduced (p<0.05). There was significant statistical discrepancy between these two groups in terms of improvement of peripheral blood carcinoembryonic antigen and tissue polypeptide antigen after 4 weeks of therapy. The complete remission rate and the efficacy rate were higher in the mutation group compared to that in the non-mutation group (p<0.05). There was a longer overall survival time after Tarceva treatment in patients with EGFR mutations than those without EGFR mutation. EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy. Detection of EGFR mutations may determine the responsiveness of malignant pleural effusion to Tarceva treatment.

Pulmonary Adenocarcinoma in Malignant Pleural Effusion Enriches Cancer Stem Cell Properties during Metastatic Cascade

“…The detached tumor cells, individually or in small clusters, are uniquely capable of proliferating and growing, despite their presumably unfavorable locale [24]. The effusions offer a premetastatic niche, which functions as a dynamic reservoir that can supply the cancer tissue through autocrine and/or paracrine interactions with growth factors.…”

CT characteristics in pulmonary adenocarcinoma with epidermal growth factor receptor mutation

“…Several reports [ 33 , 37 ] found that overall survival (OS) could be prolonged in EGFR positive ADC patients with MPE undergoing EGFR -TKI therapy. Meanwhile, several retrospective studies [ 33 , 34 ] discovered that patients with ADC and MPE had a higher rate of EGFR mutation.…”

Interstitial Lung Disease after Pleurodesis for Malignant Pleural Effusion

“…In the present study, the patients who were treated with EGFR-TKIs were mostly never smokers or light smokers and had no underlying lung diseases, highlighting the potential risk of combining EGFR-TKI therapy and pleurodesis. Considering the effectiveness of EGFR-TKIs in the treatment of EGFR-mutant lung cancer, including patients with MPE ( 12 ), EGFR-TKI therapy alone (without pleurodesis), seems be a preferable treatment option for reducing the risk of ILD. It is now widely accepted that EGFR-TKI alone (without pleurodesis) can prevent the recurrence of MPE ( 13 ).…”