Australasian Malignant PLeural Effusion (AMPLE)-3 trial: study protocol for a multi-centre randomised study comparing indwelling pleural catheter (±talc pleurodesis) versus video-assisted thoracoscopic surgery for management of malignant pleural effusion
Deirdre B. Fitzgerald,
Calvin Sidhu,
Charley Budgeon,
Ai Ling Tan,
Catherine A. Read,
Benjamin C. H. Kwan,
Nicola Ann Smith,
Edward T. Fysh,
Sanjeevan Muruganandan,
Tajalli Saghaie,
Ranjan Shrestha,
Arash Badiei,
Phan Nguyen,
Andrew Burke,
John Goddard,
Morgan Windsor,
Julie McDonald,
Gavin Wright,
Kasia Czarnecka,
Parthipan Sivakumar,
Kazuhiro Yasufuku,
David J. Feller-Kopman,
Nick A. Maskell,
Kevin Murray,
Y. C. Gary Lee
Affiliations
Deirdre B. Fitzgerald
Respiratory Medicine, Sir Charles Gairdner Hospital
Calvin Sidhu
Respiratory Medicine, Sir Charles Gairdner Hospital
Charley Budgeon
School of Population and Global Health, University of Western Australia
Ai Ling Tan
Pleural Medicine Unit, Institute for Respiratory Health
Catherine A. Read
Pleural Medicine Unit, Institute for Respiratory Health
Benjamin C. H. Kwan
Department of Respiratory and Sleep Medicine, The Sutherland Hospital
Abstract Introduction Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. Methods and analysis A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma); (ii) previous pleurodesis (vs not); and (iii) trapped lung, if known (vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. Ethics and dissemination Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. Discussion Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12618001013257 . Registered on 18 June 2018. Protocol version: Version 3.00/4.02.19
