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Efficacy and safety of Viscum album extract (Helixor-M) to treat malignant pleural effusion in patients with lung cancer

Abstract

Purpose

Manifestations of malignant pleural effusions (MPEs) are alleviated by local therapies as well as by systemic treatment. After 2009, when commercial use of talc was discontinued in Korea, we have used Helixor-M, which is derived from the European mistletoe (Viscum album), as an alternative sclerosing agent for pleurodesis. We aimed to evaluate the efficacy and safety of Helixor-M for controlling MPE.

Methods

Between 2009 and 2015, we consecutively enrolled 52 patients with lung cancer, who underwent pleurodesis to treat MPE and were analyzed retrospectively. On day 1, 100 mg of Helixor-M was instilled via pleural catheter. If the procedure was not effective, it was repeated every other day up to five times, and the dose increased each time by 100 mg. The primary study outcome was reappearance of pleural effusion at 1 month after the last pleurodesis procedure.

Results

The median age of patient was 63 years, and 77% of the 52 patients were male. About 85% of pleural effusions were found to be malignant by cytogenetic analysis. Forty-two (81%) patients were evaluable for recurrence of MPE. The 1-month recurrence rate was 48% (20/42). Among the 20 patients who developed recurrent MPE, 6 required therapeutic thoracentesis. Thirteen (25%) patients experienced procedure-related pain requiring medication. Eight (15%) had fever > 38 °C.

Conclusions

Our results suggest that a pleurodesis with Helixor-M was an effective and tolerable procedure for controlling MPE in lung cancer patients.

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References

  1. 1.

    Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ, Group BTSPDG (2010) Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax 65(Suppl 2):ii32–ii40

    Article  PubMed  Google Scholar 

  2. 2.

    Xia H, Wang XJ, Zhou Q, Shi HZ, Tong ZH (2014) Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One 9:e87060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW (1997) Respiratory failure due to insufflated talc. Lancet 349:251–252

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Rehse DH, Aye RW, Florence MG (1999) Respiratory failure following talc pleurodesis. Am J Surg 177:437–440

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    de Campos JR, Vargas FS, de Campos Werebe E, Cardoso P, Teixeira LR, Jatene FB, Light RW (2001) Thoracoscopy talc poudrage : a 15-year experience. Chest 119:801–806

    Article  PubMed  Google Scholar 

  6. 6.

    Mueller EA, Anderer FA (1990) A Viscum album oligosaccharide activating human natural cytotoxicity is an interferon gamma inducer. Cancer Immunol Immunother 32:221–227

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Bussing A, Regnery A, Schweizer K (1995) Effects of Viscum album L. on cyclophosphamide-treated peripheral blood mononuclear cells in vitro: sister chromatid exchanges and activation/proliferation marker expression. Cancer Lett 94:199–205

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Evans M, Bryant S, Huntley AL, Feder G (2016) Cancer Patients' experiences of using mistletoe (Viscum album): a qualitative systematic review and synthesis. J Altern Complement Med 22:134–144

    Article  PubMed  Google Scholar 

  9. 9.

    Stumpf C, Bussing A (1997) Stimulation of antitumour immunity by intrapleural instillation of a Viscum album L. extract. AntiCancer Drugs 8(Suppl 1):S23–S26

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513

    Article  CAS  Google Scholar 

  11. 11.

    Kim JJ, Lee SK, Choi HH (2004) Viscum album therapy in malignant pleural effusion. Korean J Thorac Cardiovasc Surg 37:978–982

    Google Scholar 

  12. 12.

    Cardillo G, Facciolo F, Carbone L, Regal M, Corzani F, Ricci A, Di Martino M, Martelli M (2002) Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions. Eur J Cardiothorac Surg 21:302–305 discussion 305-306

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Steger V, Mika U, Toomes H, Walker T, Engel C, Kyriss T, Ziemer G, Friedel G (2007) Who gains most? A 10-year experience with 611 thoracoscopic talc pleurodeses. Ann Thorac Surg 83:1940–1945

    Article  PubMed  Google Scholar 

  14. 14.

    Yildirim H, Metintas M, Ak G, Metintas S, Erginel S (2008) Predictors of talc pleurodesis outcome in patients with malignant pleural effusions. Lung Cancer 62:139–144

    Article  PubMed  Google Scholar 

  15. 15.

    Shaw P, Agarwal R (2004) Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002916.pub2

  16. 16.

    Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, Loddenkemper R, Herth FJ, Gasparini S, Marquette CH, Becke B, Froudarakis ME, Driesen P, Bolliger CT, Tschopp JM (2007) Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet 369:1535–1539

    Article  PubMed  Google Scholar 

  17. 17.

    Martinez-Moragon E, Aparicio J, Rogado MC, Sanchis J, Sanchis F, Gil-Suay V (1997) Pleurodesis in malignant pleural effusions: a randomized study of tetracycline versus bleomycin. Eur Respir J 10:2380–2383

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Davies HE, Lee YC (2013) Management of malignant pleural effusions: questions that need answers. Curr Opin Pulm Med 19:374–379

    Article  PubMed  Google Scholar 

  19. 19.

    de Giorgio A, Stebbing J (2013) Mistletoe: for cancer or just for Christmas? Lancet Oncol 14:1264–1265

    Article  PubMed  Google Scholar 

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Correspondence to Seung-Sei Lee.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Kangbuk Samsung Hospital Institutional Review Board (No. KBSMC 2016–07-045) and with the 1964 Declaration of Helsinki and its later amendments.

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Lee, YG., Jung, I., Koo, DH. et al. Efficacy and safety of Viscum album extract (Helixor-M) to treat malignant pleural effusion in patients with lung cancer. Support Care Cancer 27, 1945–1949 (2019). https://doi.org/10.1007/s00520-018-4455-z

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Keywords

  • Malignant pleural effusion
  • Pleurodesis
  • Viscum album