Malignant pleural effusion, a common complication of advanced malignancy, is associated with significant morbidity and mortality. The symptoms of MPE (dyspnea, cough, pleuritic pain) can be debilitating and can result in prolonged hospitalization at a considerable cost. Several therapeutic regimens have been designed to improve such patients’ quality of life by palliating these symptoms. Although controversy still exists as to which therapy is optimal for individual patients, a critical review of the existing management options allows patients and physicians to have open discussions on the utility of the currently available treatment strategies.