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New Agent to Manage Cancer Related Effusions

03 February 2010 Wiley

In the USA each year, 200,000 cancer patients suffer from a malignant pleural effusion - development of excessive fluid (pleural effusion) in the chest. Several litres of such fluid can accumulate, and many patients suffer from significant breathlessness and distress. One in four patients with lung cancer, one in every three with breast cancer and most of the patients with mesothelioma will develop a malignant effusion. The current strategy is to induce a pleurodesis (seal the pleural cavity with a chemical agent so no fluid can accumulate). However existing agents are far from perfect, with most producing significant side effects while delivering low success rates.

A recent issue of Respirology published by Wiley-Blackwell features two papers that propose the use of a new alternative pleurodesing agent, Iodoprovidone. They evaluate iodopovidone as a pleurodesis agent and found that it demonstrated good efficiency and safety, making it a good option in the management of malignant pleural effusion.

"There is not only a need to identify ideal pleurodesis agents, but also to standardize and optimize research tools to evaluate pleurodesis success in malignant effusions. In combination, these papers are complementary and warrant a critical appraisal of the current state of clinical research in malignant pleural effusion", said Andreas H. Diacon in an editorial published in the same issue of Respirology.

Pleurodesis is widely used to manage pleural diseases, such as malignant pleural effusion, by promoting pleural obliteration and preventing accumulation of air or fluid in the pleural space. This process would ideally alleviate shortness of breath, cough and pain associated with the presence of tumor and fluid in the pleural space.

In the paper, "Iodopovidone is as effective as doxycycline in producing pleurodesis in rabbits", researchers used a rabbit model to compare the effectiveness of iodopovidone in causing pleurodesis with that of doxycycline.

The study found that iodopovidone can induce pleurodesis as efficaciously as doxycycline and demonstrated that the desired outcome of pleurodesis can be achieved without prohibitive toxicity with a range of doses applicable to humans.

The other paper "Efficacy and safety of iodopovidone pleurodesis in malignant pleural effusions" is a retrospective analysis of iodopovidone pleurodesis in patients with malignant pleural effusions treated in a tertiary cancer institution.

Lead author Jose D.A. Neto said, "Out of the 61 pleurodesis procedures performed, no mortality was observed and less than 20 per cent presented complications. With the success rate of about 99 percent, iodopovidone appears to be a good option for the recurrent malignant pleural effusion."


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