Novel Intrapleural Therapies for Malignant Diseases

Abstract

Pleural malignancies, either primary or metastatic, are common and problematic clinical issues in thoracic oncology and pulmonary medicine. Malignant pleural mesothelioma and metastatic pleural effusions often present late in the course of a disease and have a dramatic impact on the patient’s quality of life and survival. Novel approaches to manage mesothelioma and malignant pleural effusions are desperately needed and the pleural space provides a unique platform as an easily accessible body cavity for developing and assessing these treatments and their responses. In this review, we discuss the unique intrapleural chemotherapeutic, immunotherapeutic and genetic treatments that have been investigated, as well as those under current clinical development. While responses have been demonstrated to variable degrees with all these approaches, an integrated multimodality approach incorporating these methods with other anti-neoplastic interventions ultimately will ensure the best responses and patient outcomes.

Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma

“…Clearly, with a 4-6 monthly interval of imaging, the described FFR with a median of 9 months can also only be an approximation. However, local recurrence remains an eminent problem in the treatment of MPM and represents a good point of application for novel treatment approaches such as intracavitary chemotherapy in the form of a solution or loaded to a fibrin carrier, photodynamic therapy and others [16][17][18].…”

Diagnosis and Treatment of Malignant Pleural Mesothelioma

“…To this end, different strategies, such as "suicide genes" (which make the tumor sensitive to certain drugs), administration of tumor suppressor genes, or the transfer of immunomodulatory genes to the pleural space have been proposed. [96][97][98][99] Results in the clinic are rather disheartening to date due to vector-related problems and relative inefficiency in controlling large tumor masses. However, gene therapy is most likely to be incorporated into the multimodal strategy, and when combined with nanotechnology techniques it will contribute very significantly to the improvement of treatment of malignant pleural mesothelioma in the future.…”

Diagnóstico y tratamiento del mesotelioma pleural maligno

“…Para ello se acude a diferentes estrategias como el uso de «genes suicidas» (que transfieren al tumor la capacidad de hacerse sensible a determinados fármacos), la administración de genes oncosupresores o la transferencia de genes inmunomoduladores al espacio pleural [96][97][98][99] . Aunque su aplicación clínica ha obtenido hasta ahora resultados bastante desalentadores por problemas relacionados con los vectores usados y su relativa ineficiencia para controlar una gran masa tumoral, es muy probable que la inclusión de la terapia génica en la estrategia multimodal y su combinación con técnicas basadas en nanotecnología contribuyan muy significativamente a mejorar las perspectivas de tratamiento del mesotelioma pleural maligno en el futuro.…”