How clinical trials are changing patient care

In recent years, multicenter randomized clinical trials have addressed the best approach to common clinical dilemmas in pleural disease management, including malignant pleural effusion, pleural infection, tuberculous pleural effusion, and pneumothorax. The Tuesday symposium State-of-the-Art Pleural Disease Management: Clinical Trials Changing Care Practice addresses these advances.

Chaired by V. Courtney Broaddus, MD, of the University of California, San Francisco, and David J. Feller-Kopman, MD, of Johns Hopkins Hospital, the session will focus on the results coming from clinical trials that are most relevant to the care of patients.

Dr. Broaddus, the John F. Murray Distinguished Professor of Medicine and chief of the division of pulmonary and critical care medicine at San Francisco General Hospital, highlighted the various topics of discussion during the session and what each presenter will cover.

Malignant pleural effusions. “Malignant pleural effusions, a frequent accompaniment of disseminated cancer, present a problem of persistent effusion formation and symptom management for those with a limited life span,” Dr. Broaddus says. Nick Maskell, MD, professor of respiratory medicine at the University of Bristol in the U.K., will cover the randomized trials that have defined the benefits of indwelling pleural catheters over talc pleurodesis (TIME-2 and AMPLE). He will present the most recent study, in which the indwelling pleural catheter was used together with talc pleurodesis (IPC-PLUS). In addition, he will review studies showing how to optimize indwelling pleural catheter drainage. 

Pleural infections. “Pleural infections are a common, complex, and costly pleural problem in which the drainage often is inadequate, and the management is controversial,” Dr. Broaddus says. Y.C. Gary Lee, MBChB, PhD, professor of medicine at the University of Western Australia in Perth, will show what is new since the MIST studies that established the usefulness of tPA/DNase therapy, such as newer studies that aim to refine the delivery regimes. He plans to present practical tips as well as discuss new findings that improve understanding of the pathogenesis of pleural infection. 

Tuberculous pleural effusions. Tuberculous pleural effusions continue to be a major cause of pleural effusions worldwide. Coenraad F.N. Koegelenberg, MD, PhD, of the Division of Pulmonology at the University of Stellenbosch in Cape Town, South Africa, will address the impact of new tuberculosis diagnostic tests, the rising incidence of multidrug resistance mycobacteria, and new therapeutic drugs. 

Pneumothorax. “Pneumothorax presents a challenging clinical problem, in which the optimal management is unknown, and the practice patterns vary widely,” Dr. Broaddus says. Najib Rahman, BM, MCH, MSc, DPhil, associate professor and clinical director of the Oxford Respiratory Trials Unit at the University of Oxford in the U.K., will present new data on the epidemiology of pneumothorax and the results of a recent randomized clinical trial of chemical pleurodesis at first presentation of a patient with pneumothorax. He also will present results from a study comparing no drainage versus tube drainage for primary pneumothorax that may change practice. Finally, he plans to discuss promising devices and technological approaches currently under trial. 

Biomarkers for pleural diseases. Biomarkers for the diagnosis and staging of pleural diseases would be most useful in guiding management. José M. Porcel, MD, professor and chief of internal medicine at the Hospital Universitario Arnau De Vilanova in Lleida, Spain, will present an update on new biomarkers that may impact clinical practice. 

“Overall, this symposium is aimed at covering new and useful results from studies tackling common pleural conditions,” Dr. Broaddus says. “As a result, clinicians should have a firmer basis to address these difficult problems. They will also be alerted about trials in the pipeline, with answers to be expected in the near future. It is an exciting time for clinicians caring for patients with pleural diseases.”