TAPPS shows no difference in outcomes by talc delivery method
medwireNews: Individuals with malignant pleural effusion (MPE) undergoing talc pleurodesis have comparable outcomes regardless of how the talc is delivered, shows a phase 3 trial reported in JAMA.
The TAPPS investigators compared the efficacy of talc poudrage during thoracoscopy with local anesthesia with that of talc slurry administered via a chest tube in inducing pleurodesis, and found no significant differences between the study groups for the primary or any of the secondary endpoints.
They caution, however, that “the study may have been underpowered to detect small but potentially important differences.”
But the team continues: “The current data lend further support to the development of flexible treatment pathways, with treatment for individuals with MPE tailored to the wishes, needs, and risk factors of the individual patient, with the knowledge that treatment effectiveness is unlikely to be affected by how talc is delivered.”
TAPPS is an important study that finally settles the key question of whether talc pleurodesis should be performed via poudrage or slurry.
Among the 320 trial participants – about a third of whom had lung cancer and another third had breast cancer – the primary endpoint of pleurodesis failure at 90 days occurred in 22% of 161 patients who were randomly assigned to undergo thoracoscopic talc poudrage, and by a comparable 24% of the 159 who were administered talc slurry via a chest tube.
There was similarly no difference between groups in the rates of pleurodesis failure at 30 or 180 days, and the time to pleurodesis failure was also comparable, as was the all-cause mortality rate up to 180 days from randomization.
Indeed, Rahul Bhatnagar, from the University of Bristol in the UK, and collaborators observed no statistically significant between-group differences “in any of the 24 prespecified secondary outcomes,” including patient-reported health-related quality of life endpoints.
There were 179 adverse events in the talc poudrage group and 152 in the talc slurry group, with no significant difference in the rates at 7, 30, or 180 days.
Pneumonia or chest infections, dyspnea due to fluid reaccumulation, and pneumothorax unrelated to the interventions were the most common adverse events in either group. There were more cases of surgical emphysema and pleural infection in the talc poudrage than talc slurry group, while the opposite was true for tube dislodgement.
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