Advances on the Intrapleural Management of Malignant Pleural Disease

Malignant pleural effusion (MPE) and malignant pleural disease (MPD) are common complications of cancer. Although they may significantly affect the quality of life, treatment options remain limited. Official guidelines recommend effusion drainage and pleurodesis, and, while they may achieve symptomatic relief, their impact on disease progression is limited. Intrapleural therapy has been studied for several decades due to its theoretical (and proven) superior local drug retention, maximising drug exposure. Recent works on intrapleural administration include exploring novel therapeutic agents and administration methods, such as hyperthermic intrathoracic chemotherapy (HITHOC) and pressurised intrathoracic chemotherapy (PITAC). These therapies directly modulate the tumour environments. Promising intrapleural candidates include targeted and immunotherapies such as CAR (chimeric antigen receptor)-T cells, PD-1 (programmed death protein 1) inhibitors, and IL-6 (interleukin-6) inhibitors. However, the level of evidence remains mixed, requiring further studies and quantitative synthesis.