Abstract: Malignant pleural effusion (MPE) is one of the most common complications of advanced malignant diseases. The patients with MPE have a short survival time and poor prognosis. Clinical therapeutic measures have greatly improved with the deepened exploration of the mechanisms of MPE. Diagnosis hinges on cytology, which is typically based on pleural fluid aspiration or pleural biopsy. Although numerous interventions exist, local palliative treatment is favored for the treatment of MPE. Such treatment aims to alleviate symptoms, such as aggravated dyspnea, and prolong survival time. As molecular targeted therapies and immunotherapies have developed, new diagnostic procedures and treatments have become available for patients with MPE. The recent discovery of the progrowth property of pleural fluid which may be an active promoter of cancer progression suggests that early intervention for the management of MPE may have a positive effect on inhibiting cancer progression and improving prognosis. In coming years, considerable effort should be directed at sophisticated biomarker analysis to select appropriate treatment strategies for the management of MPE.