Malignant Pleural Effusion: Finding our way through highly dynamic TIMEs

Malignant pleural effusion (MPE) is a serious complication occurring when cancer cells are found in the pleural cavity surrounding the lung. MPE is typically associated with highly metastatic disease caused by primary tumors from non-pleural tissues, but can also arise directly from cancerous transformation within the pleural lining, as seen in malignant pleural mesotheliomas. 15% of cancer patients will develop MPEs, which are associated with a dismal median survival of 3-12 months. Thus, it is imperative that efforts are made to understand the complex factors driving MPE pathophysiology. This thesis will discuss aspects currently known – and identify knowledge gaps regarding – cancer cell intrinsic MPE biology and heterotypic interactions within the tumor and immunologic pleural ecosystem. Furthermore, clinical opportunities of studying MPE will be discussed, identifying promising directions for MPE research that may result in improved disease understanding, ultimately aiming to improve clinical outcomes for these patients with advanced cancer.