The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: A prospective study

Abstract

To determine the efficacy of doxycycline in producing pleuroedesis in patients with malignant pleural effusion (MPE), 31 documented cases of MPE, aged 19-82 years were prospectively studied. Pleural sclerosis was done with 500 mg of doxycycline. Response regarding respiratory symptoms and pleural fluid accumulation were evaluated monthly. At one month, 27 patients were evaluable (4 dropped out). All responded and required no therapeutic thoracentesis. At 3 months, 13 patients dropped out, only 14 patients were evaluable. It revealed that 13 out of 14 patients (92%) responded. Only one patient failed and required therapeutic thoracentesis. Five and two patients came for assessment at 6 and 12 months, respectively. They still benefited from doxycycline pleurodesis. Side effects including low grade fever in 30% of patients, moderate to severe pain in 60% and troublesome cough with hemoptysis in one patient (3%) were noted. Doxycycline is an effective agent in controlling MPE. It was successful in every patient at 1 month and in 92% at 3 months. At 6 and 12 months quite a few patients survived for evaluation. However, they still benefited from doxycycline pleurodesis. Side effects were tolerable.

Doxycycline Induces Expression of P Glycoprotein in MCF-7 Breast Carcinoma Cells

“…Doxycycline is used for treating a variety of infectious diseases in cancer patients (29,33,44). It has also been used previously for chemical pleurodesis in patients with malignant pleural effusions (15,39) and is currently being investigated as an antiangiogenic agent for the treatment of cancer (19,23). Administration of doxycycline to cancer patients could result in clinical chemotherapeutic failure as a consequence of generating P-gp-expressing, MDR tumor cell clones.…”

Management of malignant pleural effusions

“…Doxycycline, a tetracycline analogue, has been recommended as a replacement for tetracycline. Although there are no direct studies comparing doxycycline with tetracycline, pleurodesis studies have demonstrated clinical success rates with doxycycline that are similar to those with tetracycline (historical data), with a success rate of up to 80-85% in carefully selected patients [120,126,127]. Most studies have recommended the utilization of 500 mg of doxycycline mixed with 50-100 cm 3 of sterile saline [120,127].…”

“…Although there are no direct studies comparing doxycycline with tetracycline, pleurodesis studies have demonstrated clinical success rates with doxycycline that are similar to those with tetracycline (historical data), with a success rate of up to 80-85% in carefully selected patients [120,126,127]. Most studies have recommended the utilization of 500 mg of doxycycline mixed with 50-100 cm 3 of sterile saline [120,127]. As pain is the most common complication associated with doxycycline pleurodesis, narcotic analgesic and/or conscious sedation is often recommended [126].…”

Malignant pleural effusion, current and evolving approaches for its diagnosis and management

“…Doxycycline, a tetracycline analog, demonstrated clinical success rates that are similar to those of tetracycline, up to 85% in carefully selected patients [61,88]. Most studies have recommended the utilization of 500 mg of doxycycline mixed with 50-100 ml sterile saline [61,89].…”