Experimental Treatments for Leptomeningeal Metastases from Solid           Malignancies

Sahebjam, Solmaz; Smalley, Keiran S.M.; Tran, Nam

doi:10.1177/107327481702400106

Cited by 10 publications

(8 citation statements)

References 36 publications

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“…Immunotherapies have emerged as promising therapeutic options for several types of cancer including primary malignancies of the CNS and brain metastases. However, data are very limited on the utilization of these treatment modalities in patients with LMD [ 138 ]. There are a few studies reporting on either immune checkpoint blockade, intrathecal interleukin 2 (IL-2), or intrathecal tumor-infiltrating lymphocyte (TIL) therapies.…”

Section: Therapymentioning

confidence: 99%

Leptomeningeal disease: current diagnostic and therapeutic strategies

et al. 2017

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Leptomeningeal disease has become increasingly prevalent as novel therapeutic interventions extend the survival of cancer patients. Although a majority of leptomeningeal spread occurs secondary to breast cancer, lung cancer, and melanoma, a wide variety of malignancies have been reported as primary sources. Symptoms on presentation are equally diverse, often involving a combination of neurological deficits with the possibility of obstructive hydrocephalus. Diagnosis is definitively made via cerebrospinal fluid cytology for malignant cells, but neuro-imaging with high quality T1-weighted magnetic resonance imaging can aid diagnosis and localization. While leptomeningeal disease is still a terminal, late-stage complication, a variety of treatment modalities, such as intrathecal chemotherapeutics and radiation therapy, have improved median survival from 4–6 weeks to 3–6 months. Positive prognosticative factors for survival include younger age, high performance scores, and controlled systemic disease. In looking to the future, diagnostics that improve early detection and chemotherapeutics tailored to the primary malignancy will likely be the most significant advances in improving survival.

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Section: Therapymentioning

confidence: 99%

Leptomeningeal disease: current diagnostic and therapeutic strategies

et al. 2017

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“…The biochemistry results of CSF had some diagnostic value for LM. It had been reported that the levels of white blood cells and protein in CSF increased and the levels of glucose decreased in patients with LM of NSCLC (15,16). Carcinoembryonic antigen (CEA) in CSF could also be used as a reference for the diagnosis of LM.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy analysis of Osimertinib treatment for a patient with leptomeningeal metastasis of EGFR+ non-small cell lung cancer without the T790M mutation

Hu¹,

Li²,

Zhao³

et al. 2019

Ann. Palliat. Med.

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Background: To find the method of therapy of leptomeningeal metastasis (LM) to non-small cell lung cancer (NSCLC) patient with EGFR mutation (EGFR+) but without T790M mutation.Methods: A retrospective analysis was reviewed for 5 NSCLC patients with EGFR+ who develop to LM from January 2018 to February 2019 in our hospital.Results: All five NSCLC cases were adenocarcinoma, four cases were verified existed EGFR mutation with 19 exon deletion in the first diagnosed by biopsy tissue, the other tissue was verified 21 exon mutation. Two cases were initially diagnosed with LM, and the other three cases were found metastasis with leptomeningeal respectively after 64, 3 and 4 months when the lung cancer was diagnosed. There were not verified to exist T790M mutation with EGFR+ when all the five cases developed to LM. The major symptom was headache and blurred vision. In the image scanning, two cases were not revealed, but other three cases show that multiple metastatic lesions with brain and meninges. All patients were identified existed adenocarcinoma cells in cerebrospinal fluid (CSF). Four cases were treated by the first epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and joint therapy including chemotherapy and radiotherapy, and the other case was treated by temozolomide and intrathecal chemotherapy in their earlier therapy. The curative effect was significant when they took osimertinib orally 80 mg once a day, for the disease progressing. The neurological symptoms were relieved in patient about 5-10 days after osimertinib treatment. The remission time was 10, 7, 7, 5, 4 months respectively until last following time to June 2019. The survival time was respectively 74, 7, 27, 18, and 4 months. The side effects were not increased.Conclusions: Whether EGFR+ with T790M mutation was positive or negative, osimertinib is an effective drug and can improve quality of life and prolong the survival for NSCLC patient with EGFR mutation to progress LM.

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“…6 Breast cancer, melanoma, and lung cancer, which occurs in up to 5% of cases, are the neoplasms with greater trophism for the meninges. 7 This pathology does not require a biopsy for its diagnosis and the classification according to the European Society of Neuro-oncology is based on the cerebrospinal fluid study and the magnetic resonance images. However, performing a biopsy is recommended when there is no previously demonstrated solid cancer, since the oncological treatment will depend on this.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Focal leptomeningeal disease, atypical cancer of unknown primary site in Peru

et al. 2022

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Background: Leptomeningeal metastasis is an infrequent form of cancer expression, and it has a poor prognosis due to its torpid evolution and its challenging diagnosis. Case report: We report the case of a 68-year-old woman with rapidly progressing cognitive decline and focal epilepsy. Brain magnetic resonance imaging showed extensive gyriform hypersignal in the right precentral sulcus region, without mass effect, tenuous contrast uptake, and hydrocephalus with transependymal edema. The body tomographic study was negative for solid cancer and the 18F-FDG PET-CT revealed a severe hypermetabolism in the right lung upper lobe. These findings were suggestive of lung cancer with leptomeningeal metastasis. We performed a brain biopsy, finding atypical cells in the leptomeningeal region with positive immunohistochemical staining for CK7 and negative for CK20 corresponding to lung adenocarcinoma. The patient was evaluated in the oncology service and scheduled for radiotherapy and chemotherapy. Conclusions: Focal leptomeningeal disease is an entity that should be considered as a differential diagnosis in all cases of focal leptomeningitis. Timely diagnosis and adequate cancer management can increase patient survival.

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Experimental Treatments for Leptomeningeal Metastases from Solid Malignancies

Abstract: For the first time ever, published reports suggest the tide may be turning in this challenging disease.

Cited by 10 publications

References 36 publications

Leptomeningeal disease: current diagnostic and therapeutic strategies

Leptomeningeal disease: current diagnostic and therapeutic strategies

Clinical efficacy analysis of Osimertinib treatment for a patient with leptomeningeal metastasis of EGFR+ non-small cell lung cancer without the T790M mutation

Case Report: Focal leptomeningeal disease, atypical cancer of unknown primary site in Peru

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