Intrapleural mitoxantrone for the palliative treatment of malignant pleural effusions

Abstract

Pleural effusions are common in patients with cancer and cause a significant morbidity. The optimal treatment for the control of pleural effusions is not defined. In patients with drug-sensitive tumors (e.g. breast cancer, lymphomas, small-cell lung cancer) systemic chemotherapy is the treatment of choice. For patients with other solid tumors and in recurrences despite systemic chemotherapy, the optimal treatment consists of thoracostomy-tube drainage with the instillation of a sclerosing agent [3]. Several agents are used to achieve pleuorodesis: tetracycline, bleomycin, quinacrine, nitrogen mustard, doxorubicin, mitoxantrone and talc [7]. Mitoxantrone shows a steep dose/effect relationship for different human tumor cell lines in vitro, and is a drug well tolerated locally [2]. Whilst the usual dose of mitoxantrone for intrapleural therapy is 30 mg [6], we increased the dose to 40 mg.