Update on the STREAMLINE Feasibility Clinical Trial (early pleural biopsy + indwelling pleural catheter in malignant pleural effusion)

<bold>Introduction:</bold> Malignant pleural effusion (MPE) affects 50 000 patients per year in the UK. Patients with MPE require multiple pleural procedures with prolonged time to diagnosis and fluid control. Thoracocentesis remains the guideline based first intervention in MPE, and does not prevent effusion recurrence. We have devised an accelerated pathway for patients with suspected MPE. <bold>Aims:</bold> To assess the feasibility of recruitment to a randomised trial comparing standard care (1st procedure thoracocentesis) vs accelerated pathway (1st procedure pleural biopsy + IPC) in suspected MPE. <bold>Methods:</bold> STREAMLINE is UK NIHR funded and opened to recruitment in Jan-24. The target is 40 patients randomised 1:1 between standard care and accelerated pathways. Key eligibility criteria include: pleural effusion requiring therapeutic drainage, with suspicion of malignant cause based on imaging or history of cancer. The primary outcome is feasibility of recruitment. Secondary outcomes include breathlessness (measured by 100mm VAS) over 6 weeks from first procedure, quality of life (QLQ-C30), time to treatable diagnosis and adverse events in each arm. <bold>Results:</bold> The STREAMLINE protocol was co-created with MPE patients and expert pleural clinicians to ensure emphasis on patient and healthcare priorities. As of Feb-24, 2/4 sites are open to recruitment, with 4 patients screened, 2 recruited. An update after 9 months of recruitment will be presented at the ERS congress. <bold>Conclusion:</bold> The STREAMLINE feasibility trial will determine whether a novel direct to pleural biopsy + IPC approach is feasible and provide initial information on improvement in breathlessness and quality of life.