Biology and therapy of neoplastic meningitis

Current Oncology Reports

Volumn 12, Issue 1, 2010, Pages 41-49

  Mammoser, Aaron G ^a   Groves, Morris D ^a  

^a UNIVERSITY OF TEXAS   (United States)

Author keywords

Leptomeningeal metastasis; Neoplastic meningitis

Indexed keywords

CAPECITABINE; CYTARABINE; ERLOTINIB; FLUOROURACIL; GEFITINIB; GEMCITABINE; IDOXURIDINE; IRINOTECAN; METHOTREXATE; TEMOZOLOMIDE; THIOTEPA; TOPOTECAN; TRASTUZUMAB;

BRAIN TUMOR; CANCER COMBINATION CHEMOTHERAPY; CANCER RADIOTHERAPY; CANCER SURVIVAL; CENTRAL NERVOUS SYSTEM DISEASE; CEREBROSPINAL FLUID ANALYSIS; CLINICAL TRIAL; DRUG DOSE INCREASE; DRUG EFFICACY; DRUG MEGADOSE; EXTERNAL BEAM RADIOTHERAPY; FLOW CYTOMETRY; HUMAN; MENINGITIS; NEOPLASTIC MENINGITIS; NEUROTOXICITY; NUCLEAR MAGNETIC RESONANCE IMAGING; OVERALL SURVIVAL; PATHOGENESIS; PROGNOSIS; REVIEW; SYSTEMIC DISEASE; SYSTEMIC THERAPY; TREATMENT RESPONSE; UNSPECIFIED SIDE EFFECT; WHOLE BODY RADIATION;

COMBINED MODALITY THERAPY; HUMANS; MENINGEAL NEOPLASMS; MENINGITIS;

EID: 76749103321     PISSN: 15233790     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11912-009-0079-2     Document Type: Review

References (47)

1. Groves MD: Leptomeningeal metastases: still a challenge. In ASCO Educational Book. Edited by Govindan R. Alexandria, VA: American College of Clinical Oncology; 2008:80-87.
2. MC Chamberlain 2008 Risk of neoplastic meningitis following surgical resection of cerebellar metastases J Neurooncol 89 105 107 10.1007/s11060-008- 9594-5 18438610
3. D Suki H Abouassi AJ Patel, et al. 2008 Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa J Neurosurg 108 248 257 10.3171/JNS/2008/108/2/0248 18240919 This study addresses the belief that surgical excision of metastatic brain tumors located in the posterior fossa is responsible for an increased incidence of leptomeningeal seeding. The authors found that en bloc resection of brain tumors did not carry an increased risk of NM compared with stereotactic radiosurgery. They did find an increased risk of NM with piecemeal resection compared with both en bloc resection and stereotactic radiosurgery, which held true even after a subgroup analysis accounting for tumor size and other characteristics. This paper importantly points out the need for en bloc resection to be performed whenever feasible (Pubitemid 351213287)
4. D Suki MA Hatiboglu AJ Patel, et al. 2009 Comparative risk of leptomeningeal dissemination of cancer after surgery or stereotactic radiosurgery for a single supratentorial solid tumor metastasis Neurosurgery 64 664 674 10.1227/01.NEU.0000341535.53720.3E 19197219 discussion 674-676. This retrospective study addressed the belief that surgical excision of supratentorial metastatic brain tumors is associated with an increased incidence of NM. The authors found no statistically significant difference between the incidence of NM after en bloc resection versus treatment with stereotactic radiosurgery. There was a statistically significant increase in the incidence of NM after piecemeal resection of metastases compared with either en bloc resection or stereotactic radiosurgery. The results remained statistically significant even after subgroup analysis accounting for tumor size and other characteristics. This paper importantly points out the need for en bloc resection when possible.
5. C Lin S Turner H Gurney A Peduto 2008 Increased detections of leptomeningeal presentations in men with hormone refractory prostate cancer: an effect of improved systemic therapy? J Med Imaging Radiat Oncol 52 376 381 10.1111/j.1440-1673.2008.01973.x 1:STN:280:DC%2BD1cnitlSrtQ%3D%3D 18811763 This case series illustrates the increasing incidence of NM in malignancies that were previously infrequently associated with leptomeningeal disease. The authors note that before 2004 they had not seen a case of NM in hormone refractory prostate cancer; however, between 2004 and 2006, they identified four patients in their practice. This increase is attributed to the improved survival in hormone refractory prostate cancer owing to newer treatment regimens. This raises the issues of the changing natural history of disease as newer therapies become available and the need for maintaining an awareness to the potential for NM with any underlying malignancy
6. Orphanos G, Ardavanis A: Leptomeningeal metastases from prostate cancer: an emerging clinical conundrum. Clin Exp Metastasis 2009 Nov 11 (Epub ahead of print).
7. R Vitaliani M Spinazzi AR Del Mistro, et al. 2009 Subacute onset of deafness and vertigo in a patient with leptomeningeal metastasis from ovarian cancer Neurol Sci 30 65 67 10.1007/s10072-008-0006-6 19148572
8. Y Goto N Katsumata S Nakai, et al. 2008 Leptomeningeal metastasis from ovarian carcinoma successfully treated by the intraventricular administration of methotrexate Int J Clin Oncol 13 555 558 10.1007/s10147-008-0782-2 19093186
9. WS Baek SV Kubba 2008 Cauda equina syndrome due to leptomeningeal carcinomatosis of the ovary Gynecol Oncol 111 544 545 10.1016/j.ygyno.2008.03. 002 1:STN:280:DC%2BD1cjntVOitg%3D%3D 18433846
10. RT Ignatius SM Wills L Nadeau, et al. 2008 Leptomeningeal carcinomatosis due to squamous cell carcinoma of the uterine cervix associated with HPV-45 J Clin Oncol 26 154 156 10.1200/JCO.2007.14.3180 18165650
11. N Asensio A Luis I Costa, et al. 2009 Meningeal carcinomatosis and uterine carcinoma: three different clinical settings and review of the literature Int J Gynecol Cancer 19 168 172 19258961
12. SY Oh SJ Lee J Lee, et al. 2009 Gastric leptomeningeal carcinomatosis: multi-center retrospective analysis of 54 cases World J Gastroenterol 15 5086 5090 10.3748/wjg.15.5086 19860003
13. KP Raj H Sanati RS Mehta JA Zell 2009 Need for a new treatment strategy: leptomeningeal carcinomatosis from gastric cancer Anticancer Drugs 20 301 304 10.1097/CAD.0b013e328329707c 1:CAS:528:DC%2BD1MXivFSht7k%3D 19247177
14. HG Lee B Lee SM Kim, et al. 2007 A case of gastric adenocarcinoma presenting as meningeal carcinomatosis Korean J Intern Med 22 304 307 10.3904/kjim.2007.22.4.304 18309694
15. K Sambasivaiah K Reddy AY Lakshmi, et al. 2007 Gastric cancer with isolated leptomeningeal metastases: a case report Trop Gastroenterol 28 39 40 1:STN:280:DC%2BD2srnsFOiuw%3D%3D 17896611
16. MD Groves 2003 The pathogenesis of neoplastic meningitis Curr Oncol Rep 5 15 23 10.1007/s11912-003-0082-y 12493146
17. WR Wasserstrom JP Glass JB Posner 1982 Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients Cancer 49 759 772 10.1002/1097-0142(19820215)49:4<759::AID-CNCR2820490427>3.0. CO;2-7 1:STN:280:DyaL387hsV2ltw%3D%3D 6895713
18. U Hegde A Filie RF Little, et al. 2005 High incidence of occult leptomeningeal disease detected by flow cytometry in newly diagnosed aggressive B-cell lymphomas at risk for central nervous system involvement: the role of flow cytometry versus cytology Blood 105 496 502 10.1182/blood-2004-05-1982 1:CAS:528:DC%2BD2MXltlGisw%3D%3D 15358629 (Pubitemid 40070727)
19. S Quijano A López 2009 Manuel Sancho J, et al.: Identification of leptomeningeal disease in aggressive B-cell non-Hodgkin's lymphoma: improved sensitivity of flow cytometry J Clin Oncol 27 1462 1469 10.1200/JCO.2008.17.7089 1:CAS:528:DC%2BD1MXksF2hs7Y%3D 19224854
20. MC Chamberlain 2008 Neoplastic meningitis Curr Neurol Neurosci Rep 8 249 258 10.1007/s11910-008-0038-6 18541120
21. MC Chamberlain M Glantz MD Groves WH Wilson 2009 Diagnostic tools for neoplastic meningitis: detecting disease, identifying patient risk, and determining benefit of treatment Semin Oncol 36 S35 S45 10.1053/j.seminoncol. 2009.05.005 19660682
22. MD Groves KR Hess VK Puduvalli, et al. 2009 Biomarkers of disease: cerebrospinal fluid vascular endothelial growth factor (VEGF) and stromal cell derived factor (SDF)-1 levels in patients with neoplastic meningitis (NM) due to breast cancer, lung cancer and melanoma J Neurooncol 94 229 234 10.1007/s11060-009-9819-2 1:CAS:528:DC%2BD1MXps1CjtLk%3D 19267183 This study looks at the possible role of measuring VEGF and SDF-1 levels in CSF in order to detect the presence of NM. VEGF levels were found to be elevated in 15 of 22 patients with positive CSF cytology, as well as in two patients with negative CSF that had evidence of NM on MRI. Overall, the sensitivity of VEGF levels was 67% to 75% and the specificity was 95% to 100%. Based on these results, this test may prove useful as an adjunct in the diagnosis of NM
23. Kleinschmidt-Demasters BK, Damek DM: The imaging and neuropathological effects of bevacizumab (avastin) in patients with leptomeningeal carcinomatosis. J Neurooncol 2009 Jul 16 (Epub ahead of print). The authors present two case reports of patients with non-small cell lung cancer who were being treated with bevacizumab for their systemic disease and developed nonenhancing, biopsy-proven neoplastic meningitis. This paper raises the concern that newer cancer therapies, such as the antiangiogenics, may alter imaging characteristics in NM, making diagnosis more difficult.
24. MJ Glantz BF Cole L Recht, et al. 1998 High-dose intravenous methotrexate for patients with nonleukemic leptomeningeal cancer: is intrathecal chemotherapy necessary? J Clin Oncol 16 1561 1567 1:CAS:528:DyaK1cXis1Ghtr0%3D 9552066
25. T Shigekawa H Takeuchi M Misumi, et al. 2009 Successful treatment of leptomeningeal metastases from breast cancer using the combination of trastuzumab and capecitabine: a case report Breast Cancer 16 88 92 10.1007/s12282-008-0056-x 18478315
26. M Fukuoka S Yano G Giaccone, et al. 2003 Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non-small-cell lung cancer (The IDEAL 1 Trial) [corrected] J Clin Oncol 21 2237 2246 10.1200/JCO.2003.10.038 1:CAS:528:DC%2BD2cXpsVGqu7w%3D 12748244 (Pubitemid 46621858)
27. MG Kris RB Natale RS Herbst, et al. 2003 Efficacy of gefitinib, an inhibitor of the epidermal growth factor receptor tyrosine kinase, in symptomatic patients with non-small cell lung cancer: a randomized trial JAMA 290 2149 2158 10.1001/jama.290.16.2149 1:CAS:528:DC%2BD3sXosVOnsbo%3D 14570950 (Pubitemid 37432975)
28. HG Yi HJ Kim YJ Kim, et al. 2009 Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective for leptomeningeal metastasis from non-small cell lung cancer patients with sensitive EGFR mutation or other predictive factors of good response for EGFR TKI Lung Cancer 65 80 84 10.1016/j.lungcan.2008.10.016 19059670 This retrospective study looks at patients with NSCLC and EGFR mutations who developed NM while responding systemically to treatment with gefitinib. Switching treatment to high-dose gefitinib or erlotinib, thereby effectively increasing CSF concentration of drug, resulted in improvement in 9 of 11 patients. This raises the issue of increasing survival on the incidence of NM, as well as brings to light the effects of newer treatments with poor CSF penetrance increasing the incidence of NM. Of interest is the fact that 82% of the patients responded to a similar treatment modality, suggesting this is a pharmakokinetic issue and not further mutation of the cancer
29. T Katayama J Shimizu K Suda, et al. 2009 Efficacy of erlotinib for brain and leptomeningeal metastases in patients with lung adenocarcinoma who showed initial good response to gefitinib J Thorac Oncol 4 1415 1419 10.1097/JTO.0b013e3181b62572 19692934
30. W Pao VA Miller KA Politi, et al. 2005 Acquired resistance of lung adenocarcinomas to gefitinib or erlotinib is associated with a second mutation in the EGFR kinase domain PLoS Med 2 e73 10.1371/journal.pmed.0020073 15737014 (Pubitemid 40629469)
31. S Kobayashi TJ Boggon T Dayaram, et al. 2005 EGFR mutation and resistance of non-small-cell lung cancer to gefitinib N Engl J Med 352 786 792 10.1056/NEJMoa044238 1:CAS:528:DC%2BD2MXhsFCiurk%3D 15728811 (Pubitemid 40271173)
32. MJ Glantz S LaFollette KA Jaeckle, et al. 1999 Randomized trial of a slow-release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis J Clin Oncol 17 3110 3116 1:CAS:528:DyaK1MXmslGmtL8%3D 10506606
33. MD Groves MJ Glantz MC Chamberlain, et al. 2008 A multicenter phase II trial of intrathecal topotecan in patients with meningeal malignancies Neuro Oncol 10 208 215 10.1215/15228517-2007-059 1:CAS:528:DC%2BD1cXls1GjsLk%3D 18316473
34. RJ Bernardi L Bomgaars E Fox, et al. 2008 Phase I clinical trial of intrathecal gemcitabine in patients with neoplastic meningitis Cancer Chemother Pharmacol 62 355 361 10.1007/s00280-007-0601-x 1:CAS:528:DC%2BD1cXlvVWitLg%3D 17909804 (Pubitemid 351692082)
35. C Rebischung D Hoffmann L Stefani, et al. 2008 First human treatment of resistant neoplastic meningitis by intrathecal administration of MTX plus (125)IUdR Int J Radiat Biol 84 1123 1129 10.1080/09553000802395535 1:CAS:528:DC%2BD1cXhsVOgsbjL 19061137
36. HJ Stemmler K Mengele M Schmitt, et al. 2008 Intrathecal trastuzumab (Herceptin) and methotrexate for meningeal carcinomatosis in HER2-overexpressing metastatic breast cancer: a case report Anticancer Drugs 19 832 836 10.1097/CAD.0b013e32830b58b0 1:CAS:528:DC%2BD1cXpsFKqu7o%3D 18690096
37. P Gaviani A Silvani E Corsini, et al. 2009 Neoplastic meningitis from breast carcinoma with complete response to liposomal cytarabine: case report Neurol Sci 30 251 254 10.1007/s10072-009-0044-8 19259616
38. M Glas M Stuplich H Tschampa, et al. 2008 Liposomal cytarabine given concomitantly with radiotherapy in a patient with leptomeningeal metastasis from breast cancer J Neurol 255 1838 1839 10.1007/s00415-008-0014-8 1:STN:280:DC%2BD1M%2Fns1ylsA%3D%3D 18661166
39. Passarin MG, Moretto G, Musso AM, et al.: Intrathecal liposomal cytarabine in combination with temozolomide in low-grade oligoastrocytoma with leptomeningeal dissemination. J Neurooncol 2009 Oct 31 (Epub ahead of print).
40. MC Chamberlain P Kormanik KA Jaeckle M Glantz 1999 111Indium- diethylenetriamine pentaacetic acid CSF flow studies predict distribution of intrathecally administered chemotherapy and outcome in patients with leptomeningeal metastases Neurology 52 216 217 1:STN:280:DyaK1M7hvVylsw%3D%3D 9921888
41. WA Hall BF Cole, et al. 1995 Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status Cancer 75 2919 2931 10.1002/1097-0142(19950615)75:12<2919::AID- CNCR2820751220>3.0.CO;2-9 7773943
42. LM DeAngelis 1998 Current diagnosis and treatment of leptomeningeal metastasis J Neurooncol 38 245 252 10.1023/A:1005956925637 1:STN:280: DyaK1czlvFGlug%3D%3D 9696379 (Pubitemid 28306215)
43. SS Brem PJ Bierman P Black, et al. 2005 Central nervous system cancers: Clinical Practice Guidelines in Oncology J Natl Compr Canc Netw 3 644 690 16194456
44. F Waki M Ando A Takashima, et al. 2009 Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors J Neurooncol 93 205 212 10.1007/s11060-008-9758-3 19043775
45. MC Chamberlain SK Johnston MJ Glantz 2009 Neoplastic meningitis-related prognostic significance of the Karnofsky performance status Arch Neurol 66 74 78 10.1001/archneurol.2008.506 19139302 This study addresses the contribution of KPS to prognosis in NM patients. Whereas many retrospective studies note that patients in the low performance group are less likely to be treated with IT chemotherapy, thereby clouding the interpretation, all patients in this study were treated with IT therapy. In addition, the study is control matched with regard to types of cancer and a number of other factors so that the makeup of the two groups differed essentially only by performance status. Based on this, median survival in the low performance status group was less than half of that in the good performance status group (6 weeks vs 15.5 weeks), with no patients in the poor KPS group surviving longer than10 weeks
46. J Bruna L González J Miró, et al. 2009 Leptomeningeal carcinomatosis: prognostic implications of clinical and cerebrospinal fluid features Cancer 115 381 389 10.1002/cncr.24041 19109820
47. F Clatot G Philippin-Lauridant MJ Ouvrier, et al. 2009 Clinical improvement and survival in breast cancer leptomeningeal metastasis correlate with the cytologic response to intrathecal chemotherapy J Neurooncol 95 421 426 10.1007/s11060-009-9940-2 1:CAS:528:DC%2BD1MXhtlKitbrE 19557501 This paper addresses prognostic implications of cytologic response to treatment with IT chemotherapy in a cohort of breast cancer patients. The authors propose a treatment paradigm based on treating patients with four cycles of IT chemotherapy regardless of performance status and assessing them for response, then determining whether to continue with aggressive treatment versus supportive care base on the presence or absence of a response. Of interest, four of the 11 patients who responded in their 24 patient cohort would not have been included in treatment based on current NCCN guidelines