A case of systemic lupus erythematosus or hepatitis C virus?

I applaud the efforts of Sartori et al in their prospective evaluation of bleomycin vs intrapleural interferon in patients with malignant pleural effusion. It is evident that their preliminary results are in keeping with those reported in the literature. In reviewing multiple treatment modalities for malignant pleural effusion, I have found that one common denominator in success¬ ful treatment is complete evacuation of the pleural space before definitive treatment. In that regard I feel that the 100% success I experienced in my limited group of 15 patients is because ofthe more aggressive thoracic drainage used before the high-dose interferon was instilled. In a personal communication with Dr. Muss in Wake Forest, NC, it w7as agreed that this may have been in part a cause for the limited success that he found in his excellently conducted phase II trial with intrapleural interferon.1 I will also briefly comment on the mechanism of action of bleomycin vs interferon. Although it is true that bleomycin has recently been recommended as the sclerosing drug of choice and also has been recommended for the management of malignant pericardial effusion, it should be pointed out that the primary mechanism of action, as discussed in my paper, is not one of sclerosing of the visceral and parietal surfaces. The effect of interferon appears to be related to a direct antineoplastic effect of active tumor cells within the pleural space.2 It is my impression that because there is no actual sclerosing of the surfaces, it is more imperative to drain maximally and thoroughly the pleural space of the malignant effusion before maximal high-dose inter¬ feron administration for it to be effective and achieve maximal benefit. This may in part explain why the results in this prelim¬ inary study show bleomycin to have an apparent advantage over interferon for treatment of malignant pleural effusion. One other point that I add to this communication is that in an unpublished report by our group at Columbus Hospital, we have had anec¬ dotal success in treating malignant pericardial effusion by em¬ ploying a similar method of maximal drainage of a malignant pericardial effusion by high-dose interferon before drain re¬ moval. I add my opinion to that of other authors that widening the study to include a further arm with a dosage and timing similar to that in my study will be of value. I further add that if this prospective study is done, …