Malignant pleural effusions (MPE) are a common clinical problem in patients with neoplastic disease. The development of MPEs in advanced malignancies can cause significant morbidity and mortality. Predominant symptoms of dyspnea, cough, and chest discomfort are usually debilitating. Given the poor prognosis of majority of these patients, palliation is more desirable than cure of an individual complication. Despite multiple new therapies placement of chest tube with sclerotherapy remains the standard of care. The purpose of this article is to review the emerging therapeutic options for MPE management.