Intrapleural <i>Corynebacterium parvum</i> for Recurrent Malignant Pleural Effusions

Abstract

Twenty-two consecutive patients with malignant pleural effusions (MPE) were treated with intrapleural Corynebacterium parvum (CBP) associated with parenteral methylprednisolone (MP) to determine its effectiveness and the frequency and nature of adverse reactions. After thoracentesis, 7 mg of CBP (Coparvax Wellcome) in 20 ml of saline were injected into the pleural cavity. On the day of treatment, the patients were given 1 mg/kg i.m. of MP 30 min before thoracentesis. The effectiveness of pleurodesis was assessed as follows: (1) complete response (CR; total resolution of pleural effusion after 3 injections of CBP at the most); (2) partial response (PR; formation of asymptomatic loculated effusion). In 5 patients leukocytes, lymphocytes and monocytes were determined in pleural fluid (PF) and in blood (B) collected before and 7 days after CBP treatment. Two patients were unevaluable. Of 20 evaluable patients, 18 (90%) had a CR and 2 patients (10%) had a PR. Eleven of 22 patients (50%) had a fever. Three patients had prolonged and/or high fever. Seven of 22 patients (32%) had mild chest pain. None of the patients presented other side effects. Twelve of 21 patients (57.1%) had a PF pH > 7.30; 2 of these died a few days after the treatment, and 10 had favorable responses. The other 9 patients had a PF pH < 7.30: all had favorable responses. The leukocytes, the lymphocyte subsets, the monocytes, the NK lymphocytes, and their PF/B ratios did not differ significantly before and after CBP treatment. Our study confirms that intrapleural CBP is an effective and simple method to control MPE. The combination of MP with CBP did not prevent effective pleurodesis and seems to reduce the frequency of adverse reactions, except fever.

Management of malignant pleural effusions

“…Malignant effusions with a low pH and glucose concentration have been shown to have a higher initial diagnostic yield on cytological examination, a worse survival, and a worse response to pleurodesis than those with normal pH and glucose [41][42][43][44][45]. However, other investigators have not found an association between pleural fluid pH in malignant effusions and survival or success of pleurodesis [46][47][48][49][50]. A meta-analysis of patient-level data from nine sources encompassing w400 patients, found that pleural fluid pH was an independent predictor of survival.…”

Chemotherapeutic management of malignant pleural effusion

“…C. parvum produces an intense inflammatory reaction and fever is very common (up to 50%) and nausea and chest pain are also reported. Concurrent use of parenteral methyl prednisolone appeared to reduce adverse effects but did not reduce the efficacy rate [86].…”

Seroma Prevention by Using <i>Corynebacterium parvum</i> in a Rat Mastectomy Model

“…We chose CP as a sclerosing agent for this study because of its proven efficacy in the treatment of malignant pleural effusions [14,15,22]. The mechanism by which CP inhibits fluid accumulation is not completely understood.…”

“…Corynebacterium parvum (CP) is an anaerobic, grampositive bacillus that was successfully used as a sclerosing agent in patients with malignant pleural effusions [14,15]. This study is conducted to evaluate the effects of CP on seroma formation after mastectomy and axillary dissection in an animal model.…”