Bevacizumab Treatment Of Malignant Pleural Effusion

Objective: To evaluation the efficacy and direct costs of Bevacizumab in managing of malignant pleural effusion (MPE) caused by lung adenocarcinoma.Methods: Between December 2014 to December 2016, 60 untreated patients with MPE in lung adenocarcinoma were randomly assigned to one of two groups; intrapleural injection of Bevacizumab (n= 30) or intrapleural injection of OK-432 (n= 30). Adverse events were recorded and assessed. ELISA was applied to detect the serum vascular endothelial growth factor (VEGF) level.Results: In the Bevacizumab group, fifteen (50%) and eleven (37%) patients achieved complete response (CR) and partial response (PR), respectively, 1 patient remained stable (3%), and 3 patients showed disease progression (10%). In the OK-432 group, thirteen (43%) and twelve (40%) patients achieved CR and PR, respectively, 2 patients remained stable (7%), and 4 patients showed progressed (13%). There was no statistically significant difference in the effective rate between the two groups (P> 0.05). Regarding the adverse effects, only 1 case experienced fever in the Bevacizumab group. However, for the patients in OK-432 group, chest pain, fever, dyspnea, fatigue, nausea, and anorexia were occurred in 16 (53%), 21 (70%), 5 (16.67%), 5 (16.67%), 1 (3.33%), and 7 (23.3%) cases, respectively. The incidence of adverse reactions of the patients in the OK-432 group was significantly higher than that in the Bevacizumab group (P< 0.05). In the Bevacizumab group, the serum VEGF concentration was 246.79 +/- 179.51 pg/ml before treatment and 129.85 +/- 113.09 pg/ml after treatment, suggesting the VEGF level was decreased in Bevacizumab group (P< 0.001). Median duration in hospital was 3 days in the Bevacizumab group, and less than 5 days in the OK-432 group (P< 0.001). The care cost was CNY 136.00 +/- 75.46 in the Bevacizumab group compared with CNY 201.33 +/- 66.00 in the OK-432 group (P< 0.001).Conclusion: Intrapleural injection of Bevacizumab was effective and safe for MPE, and shortened the length of hospital stay, and reduced the cost of hospitalization and nursing care.