Quinacrine (Atabrine®) in the Treatment of Neoplastic Effusions

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Abstract
Previous reports of the use of quinac rine in the local treatment of neoplastic effusions indicate that the response rate with this agent is higher and more predictable than with other drugs given intracavitarily to control effusions. Although hospitalization is usually required, and fever and local pain are common, this agent has the advantage of not producing hematopoietlc depression and is therefore useful in patients with impaired bone marrow function. Quinacrine was administered to 12 patients, several of whom had had previous unsuccessful intra-cavitary therapy. In 9 of 13 trials (69%) there was objective and subjective Improvement in the effusion. Two additional patients had objective improvement but were symptomatic from progressive systemic disease. In 2 patients, complete control of pleural effusion was obtained for 27 mo. and 19 mo. Only 1 patient in the series had recurrence of effusion prior to death. Almost all patients had fever, and 54% had local pain, but serious systemic or hematopoietic toxicity was not seen. Quinacrine apparently acts by creating a local serositis, leading to fibrosis, with partial or complete obliteration of the serous cavity. Although quinacrine inhibits several experimental tumor systems, its activity against neoplastic effusions in man apparently is not due to a cytotoxic action on tumor cells. Response seems to be correlated with the degree of inflammation and fibrosis produced.