China Oncology ›› 2024, Vol. 34 ›› Issue (7): 695-701.doi: 10.19401/j.cnki.1007-3639.2024.07.009
• Review • Previous Articles Next Articles
HUANG Sijie(), KANG Xun, LI Wenbin(
)
Received:
2024-02-28
Revised:
2024-06-10
Online:
2024-07-30
Published:
2024-08-08
Contact:
LI Wenbin
Share article
CLC Number:
HUANG Sijie, KANG Xun, LI Wenbin. Clinical research progress of intrathecal therapy in the treatment of leptomeningeal metastasis[J]. China Oncology, 2024, 34(7): 695-701.
Tab. 1
Comparison of intrathecal drugs"
Drug | Mechanism | Primary tumor | Dose | Course of treatment | Adverse events |
---|---|---|---|---|---|
MTX[ | Inhibit dihydrofolate reductase | Solid tumor | 10-15 mg | Induction: twice weekly (for 4 weeks); Consolidation: once weekly (for 4 weeks); Maintenance: once a month | Myelosuppression, EHA, white matter lesions |
Cytarabine[ | Inhibition of cellular DNA polymerization and synthesis | Solid tumor | 25-100 mg | Induction: twice weekly (for 4 weeks); Consolidation: once weekly (for 4 weeks); Maintenance: once a month | Chemical meningitis, myelosuppression |
Liposomal cytarabine[ | 50 mg | Induction: once 2 weeks (for 8 weeks); Consolidation: every 4 weeks (for 24 weeks) | |||
Thiotepa[ | Prevent the synthesis of DNA, RNA and protein by cross-linking guanine base with DNA | Solid tumor | 10 mg | Induction: twice weekly (for 4 weeks); Consolidation: once weekly (for 4 weeks); Maintenance: once a month | Myelosuppression |
Pemetrexed[ | Disrupt the normal metabolic process of folic acid dependence in cells | NSCLC | 10-50 mg | Induction: twice weekly (for 2 weeks); Consolidation: once weekly (for 4 weeks); Maintenance: once a month | Myelosuppression, gastrointestinal reaction, chemical meningitis |
Etoposide[ | Hinder the repair of damaged DNA by interfering with DNA topoisomerase Ⅱ | Solid tumor | 0.5 mg | Induction: daily (for 5 d), every other week (for 8 weeks); Consolidation: daily (for 5 d), every other week (for 4 weeks); Maintenance: daily (for 5 d), once a month | Chemical meningitis, chronic fatigue |
GemCitabine[ | Inhibition of DNA polymerase and nucleotide reductase activity | Solid tumor | 5-10 mg | Induction: twice weekly (for 6 weeks); Consolidation: once weekly (for 6 weeks); Maintenance: twice monthly for 4 months, then monthly thereafter | Neurotoxicity |
Topotecan[ | Hinder the re-linking of broken DNA single-strand | Solid tumor | 0.4 mg | Induction: twice weekly (for 6 weeks); Consolidation: once weekly (for 6 weeks); Maintenance: twice monthly for 4 months, then monthly thereafter | Chemical meningitis |
Trastuzumab[ | HER2 receptor inhibitor | Breast cancer | 80 mg | Induction: twice weekly (for 4 weeks); Consolidation: once weekly (for 4 weeks); Maintenance: 1-2 time every 2 weeks | Chemical meningitis, hydrocephalus |
IL-2[ | Stimulate the production of interferon-γ and activate T cells | Melanoma | 1.2 mU | Induction: daily for a week, then 2-3 time weekly for 3 weeks thereafter; Maintenance: 1-3 time monthly | Fever, cerebral edema |
[1] | GANI C, MÜLLER A C, ECKERT F, et al. Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumors[J]. Al, 2012, 188(2): 148-153. |
[2] | RHUN E L, WELLER M, BRANDSMA D, et al. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours[J]. Ann Oncol, 2017, 28(suppl_4): iv84-iv99. |
[3] | HOU L, HAN W X, JIN J, et al. Clinical efficacy and safety of different doses of intrathecal methotrexate in the treatment of leptomeningeal carcinomatosis: a prospective and single-arm study[J]. Jpn J Clin Oncol, 2021, 51(12): 1715-1722. |
[4] |
HERRLINGER U, FÖRSCHLER H, KÜKER W, et al. Leptomeningeal metastasis: survival and prognostic factors in 155 patients[J]. J Neurol Sci, 2004, 223(2): 167-178.
doi: 10.1016/j.jns.2004.05.008 pmid: 15337619 |
[5] |
MONTES DE OCA DELGADO M, CACHO DÍAZ B, SANTOS ZAMBRANO J, et al. The comparative treatment of intraventricular chemotherapy by ommaya reservoir vs. lumbar puncture in patients with leptomeningeal carcinomatosis[J]. Front Oncol, 2018, 8: 509.
doi: 10.3389/fonc.2018.00509 pmid: 30524956 |
[6] | RHUN E L, WELLER M, VAN DEN BENT M, et al. Leptomeningeal metastasis from solid tumours: EANO-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J]. ESMO Open, 2023, 8(5): 101624. |
[7] | HORBINSKI C, NABORS L B, PORTNOW J, et al. NCCN guidelines® insights: central nervous system cancers, version 2.2022[J]. J Natl Compr Canc Netw, 2023, 21(1): 12-20. |
[8] |
NAYAK L, FLEISHER M, GONZALEZ-ESPINOZA R, et al. Rare cell capture technology for the diagnosis of leptomeningeal metastasis in solid tumors[J]. Neurology, 2013, 80(17): 1598-1605.
doi: 10.1212/WNL.0b013e31828f183f pmid: 23553479 |
[9] | SUBIRÁ D, SIMÓ M, ILLÁN J, et al. Diagnostic and prognostic significance of flow cytometry immunophenotyping in patients with leptomeningeal carcinomatosis[J]. Clin Exp Metastasis, 2015, 32(4): 383-391. |
[10] | PALMISCIANO P, WATANABE G, CONCHING A, et al. Intrathecal therapy for the management of leptomeningeal metastatic disease: a scoping review of the current literature and ongoing clinical trials[J]. J Neurooncol, 2022, 160(1): 79-100. |
[11] | LI H Y, ZHENG S N, LIN Y J, et al. Safety, pharmacokinetic and clinical activity of intrathecal chemotherapy with pemetrexed via the ommaya reservoir for leptomeningeal metastases from lung adenocarcinoma: a prospective phase Ⅰ study[J]. Clin Lung Cancer, 2023, 24(2): e94-e104. |
[12] |
NAKAGAWA H, FUJITA T, KUBO S, et al. Ventriculolumbar perfusion chemotherapy with methotrexate and cytosine Arabinoside for meningeal carcinomatosis: a pilot study in 13 patients[J]. Surg Neurol, 1996, 45(3): 256-264.
pmid: 8638223 |
[13] | GWAK H S, LIM H S, SHIN S H, et al. Ventriculolumbar perfusion chemotherapy for the treatment of leptomeningeal carcinomatosis: a phase Ⅰ study with pharmacokinetic data[J]. Am J Clin Oncol, 2013, 36(5): 491-499. |
[14] | GWAK H S, JOO J, SHIN S H, et al. Ventriculolumbar perfusion chemotherapy with methotrexate for treating leptomeningeal carcinomatosis: a phase Ⅱ study[J]. Oncologist, 2014, 19(10): 1044-1045. |
[15] |
BEAUCHESNE P. Intrathecal chemotherapy for treatment of leptomeningeal dissemination of metastatic tumours[J]. Lancet Oncol, 2010, 11(9): 871-879.
doi: 10.1016/S1470-2045(10)70034-6 pmid: 20598636 |
[16] | 吴熙, 李峻岭, 肖建平, 等. 甲氨蝶呤鞘内注射化疗对肺癌脑膜转移的疗效分析[J]. 癌症进展, 2019, 17(8): 914-917. |
WU X, LI J L, XIAO J P, et al. Analysis of the efficacy of intrathecal methotrexate for leptomeningeal metastases from lung cancer[J]. Oncol Prog, 2019, 17(8): 914-917. | |
[17] |
HITCHINS R N, BELL D R, WOODS R L, et al. A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis[J]. J Clin Oncol, 1987, 5(10): 1655-1662.
doi: 10.1200/JCO.1987.5.10.1655 pmid: 3309199 |
[18] |
WANG N, BERTALAN M S, BRASTIANOS P K. Leptomeningeal metastasis from systemic cancer: review and update on management[J]. Cancer, 2018, 124(1): 21-35.
doi: 10.1002/cncr.30911 pmid: 29165794 |
[19] | FOWLER M J, COTTER J D, KNIGHT B E, et al. Intrathecal drug delivery in the era of nanomedicine[J]. Adv Drug Deliv Rev, 2020, 165/166: 77-95. |
[20] | RHUN E L, TAILLIBERT S, ZAIRI F, et al. A retrospective case series of 103 consecutive patients with leptomeningeal metastasis and breast cancer[J]. J Neurooncol, 2013, 113(1): 83-92. |
[21] | RHUN E L, WALLET J, MAILLIEZ A, et al. Intrathecal liposomal cytarabine plus systemic therapy versus systemic chemotherapy alone for newly diagnosed leptomeningeal metastasis from breast cancer[J]. Neuro Oncol, 2020, 22(4): 524-538. |
[22] |
GAVIANI P, CORSINI E, SALMAGGI A, et al. Liposomal cytarabine in neoplastic meningitis from primary brain tumors: a single institutional experience[J]. Neurol Sci, 2013, 34(12): 2151-2157.
doi: 10.1007/s10072-013-1358-0 pmid: 23525755 |
[23] |
RHUN E L, TAILLIBERT S, DEVOS P, et al. Salvage intracerebrospinal fluid thiotepa in breast cancer-related leptomeningeal metastases: a retrospective case series[J]. Anticancer Drugs, 2013, 24(10): 1093-1097.
doi: 10.1097/CAD.0000000000000010 pmid: 23962903 |
[24] | CHO K M, KIM Y J, KIM S H, et al. Salvage treatment with intracerebrospinal fluid thiotepa in patients with leptomeningeal metastasis after failure of methotrexate-based treatment[J]. Anticancer Res, 2015, 35(10): 5631-5638. |
[25] | SUN J M, NAM M H, CHUNG J Y, et al. Safety and pharmacokinetics of intrathecal administration of pemetrexed in rats[J]. Cancer Chemother Pharmacol, 2011, 68(2): 531-538. |
[26] | FAN C J, ZHAO Q Y, LI L, et al. Efficacy and safety of intrathecal pemetrexed combined with dexamethasone for treating tyrosine kinase inhibitor-failed leptomeningeal metastases from EGFR-mutant NSCLC-a prospective, open-label, single-arm phase 1/2 clinical trial (unique identifier: ChiCTR1800016615)[J]. J Thorac Oncol, 2021, 16(8): 1359-1368. |
[27] | GENG D, GUO Q Q, HUANG S Y, et al. A retrospective study of intrathecal pemetrexed combined with systemic therapy for leptomeningeal metastasis of lung cancer[J]. Technol Cancer Res Treat, 2022, 21: 15330338221078429. |
[28] | 谢雨文, 徐婷, 程弯弯, 等. 经Ommaya囊侧脑室注射培美曲塞治疗非小细胞肺癌伴软脑膜转移的疗效及其影响因素[J]. 中华肿瘤防治杂志, 2023, 30(17): 1034-1039. |
XIE Y W, XU T, CHENG W W, et al. Efficacy and influencing factors on intrathecal chemotherapy with pemetrexed via the Ommaya reservoir for leptomeningeal carcinomatosis from non-small cell lung cancer[J]. Chin J Cancer Prev Treat, 2023, 30(17): 1034-1039. | |
[29] | FLEISCHHACK G, REIF S, HASAN C, et al. Feasibility of intraventricular administration of etoposide in patients with metastatic brain tumours[J]. Br J Cancer, 2001, 84(11): 1453-1459. |
[30] | CHAMBERLAIN M C, TSAO-WEI D D, GROSHEN S. Phase Ⅱ trial of intracerebrospinal fluid etoposide in the treatment of neoplastic meningitis[J]. Cancer, 2006, 106(9): 2021-2027. |
[31] | PARK M J. Prolonged response of meningeal carcinomatosis from non-small cell lung cancer to salvage intrathecal etoposide subsequent to failure of first-line methotrexate: a case report and literature review[J]. Am J Case Rep, 2015, 16: 224-227. |
[32] |
EGORIN M J, ZUHOWSKI E G, MCCULLY C M, et al. Pharmacokinetics of intrathecal gemcitabine in nonhuman primates[J]. Clin Cancer Res, 2002, 8(7): 2437-2442.
pmid: 12114450 |
[33] | CHEN Y M, CHEN M C, TSAI C M, et al. Intrathecal gemcitabine chemotherapy for non-small cell lung cancer patients with meningeal carcinomatosis: a case report[J]. Lung Cancer, 2003, 40(1): 99-101. |
[34] | BERNARDI R J, BOMGAARS L, FOX E, et al. Phase Ⅰ clinical trial of intrathecal gemcitabine in patients with neoplastic meningitis[J]. Cancer Chemother Pharmacol, 2008, 62(2): 355-361. |
[35] | GROVES M D, GLANTZ M J, CHAMBERLAIN M C, et al. A multicenter phase Ⅱ trial of intrathecal topotecan in patients with meningeal malignancies[J]. Neuro Oncol, 2008, 10(2): 208-215. |
[36] |
SALGIA S, FLEMING G F, LUKAS R V. Leptomeningeal carcinomatosis from breast cancer treated with intrathecal topotecan with concomitant intravenous eribulin[J]. J Clin Neurosci, 2014, 21(7): 1250-1251.
doi: 10.1016/j.jocn.2013.09.018 pmid: 24412296 |
[37] | STEMMLER H J, SCHMITT M, WILLEMS A, et al. Ratio of trastuzumab levels in serum and cerebrospinal fluid is altered in HER2-positive breast cancer patients with brain metastases and impairment of blood-brain barrier[J]. Anticancer Drugs, 2007, 18(1): 23-28. |
[38] |
BONNEAU C, PAINTAUD G, TRÉDAN O, et al. Phase I feasibility study for intrathecal administration of trastuzumab in patients with HER2 positive breast carcinomatous meningitis[J]. Eur J Cancer, 2018, 95: 75-84.
doi: S0959-8049(18)30714-7 pmid: 29635147 |
[39] | KUMTHEKAR P U, AVRAM M J, LASSMAN A B, et al. A phase Ⅰ/Ⅱ study of intrathecal trastuzumab in human epidermal growth factor receptor 2-positive (HER2-positive) cancer with leptomeningeal metastases: safety, efficacy, and cerebrospinal fluid pharmacokinetics[J]. Neuro Oncol, 2023, 25(3): 557-565. |
[40] | ZAGOURI F, SERGENTANIS T N, BARTSCH R, et al. Intrathecal administration of trastuzumab for the treatment of meningeal carcinomatosis in HER2-positive metastatic breast cancer: a systematic review and pooled analysis[J]. Breast Cancer Res Treat, 2013, 139(1): 13-22. |
[41] | FIGURA N B, RIZK V T, MOHAMMADI H, et al. Clinical outcomes of breast leptomeningeal disease treated with intrathecal trastuzumab, intrathecal chemotherapy, or whole brain radiation therapy[J]. Breast Cancer Res Treat, 2019, 175(3): 781-788. |
[42] | GLITZA I C, SMALLEY K S M, BRASTIANOS P K, et al. Leptomeningeal disease in melanoma patients: an update to treatment, challenges, and future directions[J]. Pigment Cell Melanoma Res, 2020, 33(4): 527-541. |
[43] | GLITZA I C, ROHLFS M, GUHA-THAKURTA N, et al. Retrospective review of metastatic melanoma patients with leptomeningeal disease treated with intrathecal interleukin-2[J]. ESMO Open, 2018, 3(1): e000283. |
[44] | FIGURA N B, RIZK V T, ARMAGHANI A J, et al. Breast leptomeningeal disease: a review of current practices and updates on management[J]. Breast Cancer Res Treat, 2019, 177(2): 277-294. |
[45] |
GLITZA OLIVA I C, FERGUSON S D, BASSETT R JR, et al. Concurrent intrathecal and intravenous nivolumab in leptomeningeal disease: phase 1 trial interim results[J]. Nat Med, 2023, 29(4): 898-905.
doi: 10.1038/s41591-022-02170-x pmid: 36997799 |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||
沪ICP备12009617
Powered by Beijing Magtech Co. Ltd