Management of malignant pleural effusion

Simpson, Graham; Judge, Daniel

doi:10.1111/resp.12447

Cited by 7 publications

(10 citation statements)

References 3 publications

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“…Malignant pleural effusion (MPE) is a complication that occurs in 30% of lung cancers. MPE can induce terminal cancers and is associated with poor prognosis . Immune dysfunction often occurs in MPE, and although it is common, very little information is available regarding the underlying mechanism.…”

Section: Introductionmentioning

confidence: 99%

Impaired T cell function in malignant pleural effusion is caused by TGF‐β derived predominantly from macrophages

Wang

et al. 2016

Intl Journal of Cancer

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Malignant pleural effusion (MPE) is an indication of advanced cancer. Immune dysfunction often occurs in MPE. We aimed to identify the reason for impaired T cell activity in MPE from lung cancer patients and to provide clues toward potential immune therapies for MPE. The surface inhibitory molecules and cytotoxic activity of T cells in MPE and peripheral blood (PB) were analyzed using flow cytometry. Levels of inflammatory cytokines in MPE and PB were tested using ELISA. TGF-β expression in tumor-associated macrophages (TAMs) was also analyzed. The effect of TAMs on T cells was verified in vitro. Lastly, changes in T cells were evaluated following treatment with anti-TGF-β antibody. We found that expression levels of Tim-3, PD-1 and CTLA-4 in T cells from MPE were upregulated compared with those from PB, but levels of IFN-γ and Granzyme B were downregulated (p < 0.05). The amount of TGF-β was significantly higher in MPE than in PB (p < 0.05). TGF-β was mainly produced by TAMs in MPE. When T cells were co-cultured with TAMs, expression levels of Tim-3, PD-1 and CTLA-4 were significantly higher than controls, whereas levels of IFN-γ and Granzyme B were significantly decreased, in a dose-dependent manner (p < 0.05). In vitro treatment with anti-TGF-β antibody restored the impaired T cell cytotoxic activity in MPE. Our results indicate that macrophage-derived TGF-β plays an important role in impaired T cell cytotoxicity. It will therefore be valuable to develop therapeutic strategies against TGF-β pathway for MPE therapy of lung cancer.

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Section: Introductionmentioning

confidence: 99%

Impaired T cell function in malignant pleural effusion is caused by TGF‐β derived predominantly from macrophages

Wang

et al. 2016

Intl Journal of Cancer

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“…We read with interest that Dr Simpson reports a success rate of 90% in their patients undergoing pleurodesis by medical thoracoscopy. 1 We strongly encourage that they publish the data and share this exciting finding and how it was achieved.…”

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confidence: 95%

“…5,9 Importantly, most (>90%) patients fitted with an IPC never required further invasive pleural drainages in their remaining life-compared with over 30% who underwent talc pleurodesis. 1,5,10 The systematic review by Van Meter et al quotes a spontaneous pleurodesis rate of 45.6% in MPE patients treated with an IPC; subsequent studies concur with rates up to 57%, thus allowing for IPC removal in this patient group. 5,11 We are not aware of data that support the views of Simpson and Judge that 'IPC may have become the preferred modality in many centres because of the lack of access to medical thoracoscopy'.…”

mentioning

confidence: 99%

“…We thank Drs Simpson and Judge for the opportunity to appease their concerns. 1 The quoted approximate 30% failure rate of talc pleurodesis referred to results from the widely cited Dresler et al study 2 -the largest prospective randomized trial (n = 501) conducted in malignant pleural effusion (MPE) management. The study randomized MPE patients to talc pleurodesis either by thoracoscopic insufflation (poudrage) or slurry via a chest tube.…”

mentioning

confidence: 99%

“…5,11 We are not aware of data that support the views of Simpson and Judge that 'IPC may have become the preferred modality in many centres because of the lack of access to medical thoracoscopy'. 1 There remains a dearth of long-term randomized data evaluating the need for repeat pleural interventions over an individual MPE patient's lifetime. MPE patients represent a heterogenous group, and it is over-simplistic to adopt a single therapeutic approach.…”

mentioning

confidence: 99%

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