Individuals with malignant pleural effusions without substantial lung entrapment treated with the placement of an indwelling pleural catheter and administration of talc powder may have a greater chance of pleurodesis compared with treatment with an indwelling pleural catheter alone, according to a study published by the New England Journal of Medicine.

Researchers recruited 154 individuals from 18 different centers in the United Kingdom over the course of 4 years and randomly assigned them to receive either 4 g talc slurry (n=78) or placebo (n=76) through an indwelling pleural catheter in an outpatient setting. The administration was performed on a single-blind basis, with follow-up for 70 days. The successful pleurodesis at day 35 after randomization was the primary outcome.

Successful pleurodesis was seen in 30 (43%) of 69 patients in the talc group compared with 16 (23%) of 70 patients in the placebo group (hazard ratio, 2.20; 95% CI, 1.23-3.92; P =.008). At day 70, successful pleurodesis was reported in 35 (51%) of 69 patients in the talc group and 19 (27%) of 70 patients in the placebo group (hazard ratio, 2.24; 95% CI, 1.31-3.85; P =.003). No difference between groups regarding effusion size on thoracic ultrasonography assessment was reported.

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The mean hospital length of stay was slightly higher in the talc group (4.1±7.9 days) compared with the placebo group (3.0±5.2 days); however, these results were not statistically significant (rate ratio, 1.16; 95% CI, 0.50-2.70; P =.74). There were 21 deaths during the study: 7 in the talc group and 14 in the placebo group. However, these results were also not statistically significant despite the odds ratio favoring the talc group (odds ratio, 0.45; 95% CI, 0.17-1.24; P =.13). There were no differences in the number of participants who had adverse events.

Researchers concluded that in patients without substantial lung entrapment, the administration of talc through an indwelling pleural catheter was significantly more effective at achieving pleurodesis compared with the use of an indwelling pleural catheter alone. Clinicians should therefore seriously consider this treatment option in patients with malignant pleural effusions.

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Disclosures: This study was funded by Becton Dickinson. Some of the researchers report financial relationships with pharmaceutical and medical device companies.


Bhatnager R, Keenan EK, Morley AJ, et al. Outpatient talc administration by indwelling pleural catheter for malignant effusion. N Engl J Med. 2018;378:1313-1322.