Doxil-induced regression of pleuro-pulmonary metastases in a patient with malignant meningioma

Abstract

Metastatic meningioma is a rare disease, which has no effective chemotherapy. We report on a treatment of this condition with Doxil, a liposomal doxorubicin formulation. A 60-year-old woman with massive pleuro-pulmonary metastases from recurrent cranial meningioma was treated with Doxil (50-37.5 mg/m2) for 18 months with near-complete resolution of metastases and disappearance of pleural fluid. The only significant toxicities observed were stomatitis and hand-foot syndrome, which resolved with dose reduction and increase of dosing intervals. Doxil was cleared very slowly in this patient with a monoexponential half-life of 108 h. The patient remains in near-complete response for 6 months after treatment discontinuation. This is the first report on an effective chemotherapy in a patient with typical metastatic meningioma. The exact mechanism accounting for such an effective drug action is not clear, but may be related to a particularly high microvascular permeability to the liposome carriers in these metastatic lesions.

Two cases of atypical meningioma with pulmonary metastases: A comparative cytogenetic analysis of chromosomes 1p and 22 and a review of the literature

“…FDG ( 18 fluorodeoxyglucose) positron emission tomography or somatostatin‐receptor scintigraphy using (111) In‐pentreotide were successfully implemented to detect distant meningioma metastases in single patients . Individual treatment trials with different chemotherapeutic agents were initiated in some patients . Agents used included single agents, that is, Doxil or a combination of multiple substances such as vincristine, adriamycin and cyclophosphamide .…”

Multiple Extracranial Metastases of Atypical Meningiomas

“…Postoperative radiation therapy has been recommended for the prevention of local recurrence, especially when the resection is partial or when the histology suggests malignancy 2) . There are some reports indicating good results obtained with chemotherapy 17) . However, traditional chemotherapy has little benefit, even in histologically atypical or malignant meningiomas 1) .…”

Recurrent rhabdoid meningioma with lymph node, pulmonary and bone metastases: a diagnostic and therapeutic challenge

“…A second patient with cervical metastases was treated with systemic interferon alpha2-b and external beam radiotherapy, but expired 5 months later. Other reports of successful treatment of meningioma metastases to lymph node with adjuvant intensity-modulated radiotherapy, and of pleura-pulmonary metastases with doxorubicin are available in the literature [13,14]. However, Wang et al administered methotrexate, cytarabine, and dexamethasone to a patient with liver metastases from rhabdoid meningioma, with progressive worsening [5].…”