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鞘内注射治疗实体瘤脑膜转移的临床研究进展
Clinical research progress of intrathecal therapy in the treatment of leptomeningeal metastasis
- 中国癌症杂志 2024年34卷第7期 页码：695-701
- 作者机构：
首都医科大学附属北京天坛医院神经肿瘤综合治疗中心，北京 100070
- 作者简介：
[ "黄思捷（ORCID: 0000-0002-5182-8751），硕士。" ]
李文斌（ORCID: 0000-0001-7638-4395），博士，主任医师。
- 基金信息：2020年国家和省级临床重点专科能力建设项目
DOI：10.19401/j.cnki.1007-3639.2024.07.009
中图分类号： R730.5收稿：2024-02-28，
修回：2024-06-10，
纸质出版：2024-07-30
- 稿件说明：
移动端阅览
黄思捷, 康勋, 李文斌. 鞘内注射治疗实体瘤脑膜转移的临床研究进展[J]. 中国癌症杂志, 2024,34(7):695-701.
Sijie HUANG, Xun KANG, Wenbin LI. Clinical research progress of intrathecal therapy in the treatment of leptomeningeal metastasis[J]. China Oncology, 2024, 34(7): 695-701.
黄思捷, 康勋, 李文斌. 鞘内注射治疗实体瘤脑膜转移的临床研究进展[J]. 中国癌症杂志, 2024,34(7):695-701. DOI： 10.19401/j.cnki.1007-3639.2024.07.009.
Sijie HUANG, Xun KANG, Wenbin LI. Clinical research progress of intrathecal therapy in the treatment of leptomeningeal metastasis[J]. China Oncology, 2024, 34(7): 695-701. DOI： 10.19401/j.cnki.1007-3639.2024.07.009.
摘要
脑膜转移（leptomeningeal metastasis，LM）是实体瘤患者的严重晚期并发症，常见于肺癌、乳腺癌及黑色素瘤患者中。近年来，由于诊断技术的进步，LM的诊出率逐渐上升。LM治疗的主要目标是维持患者的神经功能，改善生活质量，提高总生存率并延长无进展生存期。鞘内注射治疗是LM的主要治疗方法之一，能够直接将药物递送至蛛网膜下隙。传统的鞘内注射化疗药物包括甲氨蝶呤、阿糖胞苷及塞替哌等。随着新药研究的开展，多种化疗药物、靶向药物及免疫检查点抑制剂等也被尝试用于鞘内注射治疗。此外，不同的鞘内给药方式也给患者带来新希望。本文将对鞘内注射治疗LM的临床研究进展进行综述。
Abstract
Leptomeningeal metastasis (LM) is a serious late complication in patients with solid tumors
which is common in patients with lung cancer
breast cancer and melanoma. In recent years
due to the progress of diagnosis
the diagnosis rate of LM has gradually increased. The main goal of the therapy is to maintain neurological function
improve the quality of life and the overall survival rate
and prolong the progression-free survival time of patients. Intrathecal therapy is one of the main treatments for LM
which can deliver drugs directly to the subarachnoid space. The traditional intrathecal drugs are methotrexate
cytarabine and thiotepa. With the development of new research
a variety of chemotherapeutic drugs
targeted drugs and immune checkpoint inhibitors have also been used in intrathecal therapy. In addition
different ways of intrathecal administration also bring new hope to patients. This article reviewed the clinical research progress of intrathecal therapy in the treatment of LM.
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Keywords
references
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 .
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.
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 .
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 http://doi.org/10.1016/j.jns.2004.05.008
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 http://doi.org/10.3389/fonc.2018.00509
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 .
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 .
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 http://doi.org/10.1212/WNL.0b013e31828f183f
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 .
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 .
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.
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 .
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 .
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 .
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 http://doi.org/10.1016/S1470-2045(10)70034-6
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 .
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 http://doi.org/10.1200/JCO.1987.5.10.1655
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 http://doi.org/10.1002/cncr.30911
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 .
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 .
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 .
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 http://doi.org/10.1007/s10072-013-1358-0
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 http://doi.org/10.1097/CAD.0000000000000010
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 http://doi.org/10.1016/j.jocn.2013.09.018
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 .
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 http://doi.org/S0959-8049(18)30714-7
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 .
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 .
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 .
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 .
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 .
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 .
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 http://doi.org/10.1038/s41591-022-02170-x
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