Indwelling Pleural Catheters With or Without Doxycycline in Treating Patients With Malignant Pleural Effusions

Study Overview
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Brief Summary
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This study is designed to obtain preliminary data comparing indwelling pleural catheters (IPCs) versus IPCs plus doxycycline for pleurodesis as treatments for malignant pleural effusion (MPE). Indwelling pleural catheters (IPCs) are commonly used to treat pleural effusions (build-up of fluid in the lungs). Doxycycline is an antibiotic that is also used to treat pleural effusions. The goal of this clinical research study is to learn if adding doxycycline to the use of an IPC can lead to shorter treatment times with IPCs.

Detailed Description
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PRIMARY OBJECTIVES: I. To obtain preliminary data comparing indwelling pleural catheters (IPCs) versus IPCs plus doxycycline for pleurodesis as treatments for malignant pleural effusion (MPE). OUTLINE: Patients choose 1 of 2 groups. GROUP I: Patients undergo IPC placement and receive doxycycline via IPC 5 days later. GROUP II: Patients undergo IPC placement. After completion of study treatment, patients are followed up at 10-14 days and then monthly for up to a year.

Official Title
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A Prospective Observational Cohort Study of Indwelling Pleural Catheters Versus Indwelling Pleural Catheters Plus Doxycycline Pleurodesis for Treatment of Malignant Pleural Effusions

Conditions
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Pleural Neoplasm

Intervention / Treatment
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* Drug: Doxycycline
* Device: Indwelling Catheter
* Procedure: Quality-of-Life Assessment
* Other: Questionnaire Administration
* Other: Survey Administration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Outpatients with MPE undergoing IPC placement Sufficient mental capacity to provide informed consent and answer Short-Form Six-Dimension health index (SF-6D) and Borg score questions Inpatients that are expected to be discharged within 5 days of receiving an indwelling pleural catheter Exclusion Criteria: Patients undergoing pleurodesis for benign disease (e.g., spontaneous pneumothorax) Inability or unwillingness to give informed consent Inability to perform phone call and clinical follow-up at MD Anderson Cancer Center (MDACC) Pregnancy Previous intrapleural therapy for MPE on the same side Eastern Cooperative Oncology Group (ECOG) of 4 and life expectancy =< 2 weeks Doxycycline allergy Extensive loculations or hydropneumothorax or other contraindication to pleurodesis Chylous effusions associated with malignant disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 2 (IPC alone)<br>Patients undergo IPC placement. | Device: Indwelling Catheter<br>* Receive IPC<br>Procedure: Quality-of-Life Assessment<br>* Ancillary studies<br>* Other names: Quality of Life Assessment;Other: Questionnaire Administration<br>* Ancillary studies<br>Other: Survey Administration<br>* Ancillary studies<br>|
| Group I (IPC, doxycycline)<br>Patients undergo IPC placement and receive doxycycline via IPC 5 days later. | Drug: Doxycycline<br>* Receive via IPC<br>* Other names: Doxycycline Monohydrate;Device: Indwelling Catheter<br>* Receive IPC<br>Procedure: Quality-of-Life Assessment<br>* Ancillary studies<br>* Other names: Quality of Life Assessment;Other: Questionnaire Administration<br>* Ancillary studies<br>Other: Survey Administration<br>* Ancillary studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to pleural catheter removal | This outcome will be analyzed by cause-specific hazard Cox model with treatment group as a covariate. Whenever a catheter is removed, the cause for removal will be documented. For the analysis, causes will include removal due to decreased drainage (i.e., as per plan) as well as removal due to complications (e.g. infection, empyema, refractory pain) or other reasons (e.g. catheter plugged but no complication to the patient, patient preference without a complication). We will also analyze time to catheter removal for any cause and conduct pre-specified secondary analyses to evaluate the effect of fluid drainage amount (i.e., how much was being put out from the indwelling pleural catheter (IPC) the day of IPC placement and on the day of doxycycline instillation) and size of residual effusion as assessed by chest x-ray (CXR) (on day of IPC placement and day of doxycycline instillation) on time to catheter removal. | Up to 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recurrence of effusion requiring drainage after IPC |  | Up to 1 year | 
| Indwelling pleural catheters (IPC) complications |  | Up to 1 year | 
| Quality-adjusted survival measured using Short-Form Six-Dimension health index (SF-6D) | Will use the Kaplan-Meier product-limit method to estimate median quality-adjusted life years (QALYs) following IPC placement. | Baseline up to 1 year | 
| Change in dyspnea using Borg score | Will use paired t-test to compare baseline and 1 month Borg scores and utilities. A generalized linear model will be used to evaluate whether other variables have any impact on the pairwise differences between baseline and 1 month. | Baseline up to 1 year | 
| Assessment of symptom burden |  | Baseline up to 1 year | 
| Procedure-associated pain |  | Up to 1 year | 
| Need for hospitalization due to pleurodesis pain |  | Up to 1 year |