Effectiveness of EGFR-tyrosine kinase inhibitors (TKI) versus EGFR-TKIs plus talc pleurodesis in preventing recurrence of malignant pleural effusion (MPE) in advanced lung adenocarcinoma.

e21684 Background: Approximately 15% of patients have pleural effusion at the initial diagnosis of advanced lung cancer. The best treatment approach to prevent re-accumulation of symptomatic MPE after initial thoracentesis remains unclear; especially in EGFR Mutation positive advanced lung cancer patients. Methods: An observational cohort study of 70 patients hospitalized with lung adenocarcinoma and MPE in the year 2012 was conducted. Treatment approach to the MPE after initial thoracentesis (including use of talc pleurodesis) was assessed and time to recurrence of MPE, if any was recorded. Results: Among patients with EGFR mutation positive lung cancer receiving TKI as first line therapy (n = 34), those with pleurodesis (n = 14) and those without pleurodesis (n = 20) showed similar effusion-recurrence-free survival after initial drainage, 9.9 vs. 11.7 months, p = 0.80 respectively. In the entire cohort, effusion-recurrence-free survival was 3.2 vs. 3.9 months in no-pleurodesis and pleurodesis group respectively using talc as the sclerosing agent. Effusion-recurrence-free survival was significantly longer in EGFR positive group(10.8 months) treated with TKIs vs. 1.8 month in EGFR negative group (p = 0.006). More patients (n = 10, 25.6%) with activating EGFR mutation presented with complete opacification (white-out) of the hemithorax compared to none without activating EGFR mutation (p = 0.02) Conclusions: In lung adenocarcinomas presenting with symptomatic MPE, use of EGFR-TKI alone was associated with the longest effusion-recurrence-free survival. In TKI eligible patients, early talc pleurodesis confers no additional benefit and should be reserved for non-adenocarcinoma histology, wild type EGFR or EGFR negative adenocarcinoma.