Prognostic biomarkers discovered for patients with malignant pleural effusion

In a collaboration spanning multiple departments within Oxford and beyond, Centre members led by Dr Ioannis Psallidas have developed a new risk score (PROMISE score) that can provide important information on patient prognosis, and guide the selection of appropriate management strategies for patients with malignant pleural effusion.

Malignant pleural effusion is defined as the accumulation of a significant amount of fluid in the pleural space, accompanied by the presence of malignant cells or tumour tissue. It is commonly associated with breast and lung metastases, but the majority of late stage cancer could develop this type of metastasis. Currently, patients suffering from malignant pleural effusion have poor prognosis, with median survival ranging from 3 to 12 months. Additionally, the incidence of this condition is on the rise due to the increase in cancer prevalence and therapy improvements that allow patients to live for longer.

The most common treatment of malignant pleural effusion is pleudodesis, which involves the induction of pleural inflammation and fibrosis to prevent fluid accumulation. To improve the stratification of treatment for patients and to aid the understanding of the mechanisms underlying disease progression, prognostic biomarkers need to be identified. The PROMISE study was designed with the objectives to discover, validate, and prospectively assess biomarkers of survival and pleurodesis response in malignant pleural effusion.

Researchers discovered four proteins associated with patient survival that were independent of the cancer type. The data from one protein named tissue inhibitor of metalloproteinases 1 was combined with seven clinical biomarkers to build a score that predicts risk of death within 3 months. These four proteins that were associated with predicting survival also have potential as targets for novel treatments.

Ioannis remarked ‘The PROMISE score provides a valuable tool for clinicians to help stratify patients with malignant pleural effusion. Those of which have good prognosis can be identified for clinical trials of novel treatments. The patients with poorer prognosis can be treated symptomatically, reducing the number of hospital visits and procedures, such as pleudodesis, which may result in mortality. In the future we will be to aiming to secure funding to set up trials to investigate the effects of targeting the proteins identified in this study’.

The PROMISE study results have been published in Lancet Oncology.