Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions.

Talc has been used to treat malignant pleural effusions (MPE) for over 30 years and is usually considered to be the most effective chemical agent for pleurodesis. Clinicians, aware of limited reports of serious adverse effects attributed to talc, have generally reserved it for selected patients who are refractory to first-line chemical sclerosants. Tetracycline and bleomycin have therefore been cited as the preferred agents for the treatment of MPE. Clinical studies reported over the last 5 years reflect a continuing interest in talc as a chemical sclerosant and provide evidence of its effectiveness with minimal side effects. Comparisons with other agents are necessary to evaluate further the application of talc insufflation in the thoracoscopy suite and talc slurry at the patient's bedside. As clinicians continue to debate the relative merits of various pleurodesis agents, talc appears to be a reasonable choice for the treatment of MPE.