Efficacy and safety of recombinant human tumor necrosis factor application for the treatment of malignant pleural effusion caused by lung cancer

Malignant pleural effusion (MPE) signifies a poor prognosis for patients with lung cancer. For treating physicians, the primary goals are to achieve sufficient control of MPE and minimize invasive intervention. Recombinant human mutant tumor necrosis factor‐alpha (rhu‐TNF) has been used in the treatment of MPE. The aim of our research was to evaluate the efficacy and safety of rhu‐TNF application via ultrasound‐guided chest tube for the treatment of MPE. rhu‐TNF was administered as a single dose to 102 patients with MPE caused by lung cancer, and dexamethasone (Dxm, 5 mg) was administered 30 minutes before rhu‐TNF in 35 randomly selected patients in order test its ability to prevent side effects. The primary endpoint was the efficacy of the rhu‐TNF treatment (disease response rate) and side effects (pain, fever, and flu‐like symptoms), evaluated four weeks after instillation. The disease response rate of rhu‐TNF treatment was 81.37%. Side effects included 13 (12.75%) patients complaining of flu‐like symptoms, 15 (14.71%) with fever/chill, and 14 (13.73%) with chest pain. A significantly higher efficacy was observed for treatment with 3 MU versus 2 MU of rhu‐TNF (P = 0.036), while the adverse effects were similar. There was no significant association between the dose of rhu‐TNF and progression‐free survival (P = 0.752). In conclusion, our study shows that intra‐pleural instillation of rhu‐TNF achieves sufficient control of MPE and minimizes invasive intervention.