Abstract Rationale Malignant pleural effusions (MPEs) are common and significant complications of non-small cell lung cancer (NSCLC) with nearly 15% of patients having a MPE at time of initial cancer diagnosis. The finding is independently associated with decreased survival. Although recent advances in treatment with immunotherapy have improved prognosis and survival in NSCLC, their impact on treatment of MPEs is less clear. We hypothesized that patients with NSCLC treated with immunotherapy are less likely to receive definitive pleural effusion management given their anticipated favorable response. Methods A cohort of 80 patients with NSCLC and MPE who were treated with any systemic therapy from January 2010 through February 2024 were analyzed as part of a retrospective single-center study. Patients were categorized by the type of systemic therapy received: immunotherapy alone, combination immunotherapy with chemotherapy, or chemotherapy alone. Definitive pleural effusion management included chest tube pleurodesis, indwelling pleural catheter (IPC), or thoracoscopy with pleurodesis Results Of these 80 patients reviewed with NSCLC and MPE, 41 received immunotherapy as part of their systemic treatment while 39 patients were treated with chemotherapy alone. The immunotherapy cohort saw 21/41 (51%) patients receive definitive intervention while non-immunotherapy patients had 18/39 (46%) definitive interventions take place. In both groups, all definitive interventions were IPCs. The immunotherapy group was more likely to have their IPC removed, 14 (66%) patients compared to 7 (33%). The median time from initial cancer diagnosis to IPC placement in patients that received immunotherapy was 116 (IQR 34,611) days as opposed to the non-immunotherapy cohort that received definitive intervention sooner at 61 (IQR 20, 326) days. Similarly, lengths of time from MPE identification to IPC was shorter in the non-immunotherapy group with a median of 6 days compared to 28 days. Conclusion This initial data suggests that patients with NSCLC who received immunotherapy were just as likely to require definitive management for MPEs, but the timing of IPC placement was almost twice as long after initial malignancy diagnosis compared to their non-immunotherapy cohort. The cohort receiving immunotherapy was also more likely to have their IPC removed, suggesting more rapid pleurodesis. This abstract is funded by: None
Higgins et al. (Fri,) studied this question.