Indwelling Pleural Catheters versus Pleurodesis for Malignant Pleural Effusion (TIME2)

Malignant pleural effusion (MPE) causes significant dyspnea. Two main management options: talc pleurodesis (requires hospitalization) or indwelling pleural catheter (IPC, outpatient management). TIME2 was the first RCT comparing these strategies.

Multicenter RCT (7 UK centers, n=106) comparing IPC vs. talc pleurodesis for symptomatic MPE.

IPC and talc pleurodesis provided equivalent dyspnea relief at 42 days (primary endpoint). IPC patients had shorter initial hospitalization (0 vs 4 days). IPC patients had more adverse events (cellulitis, pleural infections). 46% of IPC patients achieved spontaneous pleurodesis.

IPC and talc pleurodesis are equivalent for symptom control in MPE. IPC is preferred for: outpatient management, trapped lung, poor performance status, or short life expectancy. Talc pleurodesis is preferred for: patients likely to achieve pleurodesis, longer life expectancy. 46% of IPC patients achieve auto-pleurodesis.

Small sample size. Short follow-up (42 days primary endpoint). Predominantly UK population.