Concurrent intrathecal methotrexate and liposomal cytarabine for leptomeningeal metastasis from solid tumors: a retrospective cohort study
| Autor: | Barbara A. Parker, Marlon Garzo Saria, Lyudmila Bazhenova, Clark C. Chen, Teresa Helsten, Vincent A. van Vugt, Sandeep C. Pingle, Bob S. Carter, Tiffany A. Brown, David Piccioni, Toni Rush, Paul T. Fanta, Santosh Kesari, Brian J. Scott, Bradley D. Brown, Richard Schwab |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Oncology Antimetabolites Antineoplastic Cancer Research medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Breast Neoplasms Kaplan-Meier Estimate Disease-Free Survival law.invention Randomized controlled trial law Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Karnofsky Performance Status Injections Spinal Dexamethasone Aged Retrospective Studies Chemotherapy business.industry Age Factors Cytarabine Cancer Retrospective cohort study Middle Aged medicine.disease Surgery Methotrexate Treatment Outcome Neurology Tolerability Liposomes Feasibility Studies Premedication Neurology (clinical) business Meningeal Carcinomatosis medicine.drug |
| Zdroj: | Journal of Neuro-Oncology. 119:361-368 |
| ISSN: | 1573-7373 0167-594X |
| DOI: | 10.1007/s11060-014-1486-2 |
| Popis: | Leptomeningeal metastasis (LM) from solid tumors is typically a late manifestation of systemic cancer with limited survival. Randomized trials comparing single agent intrathecal methotrexate to liposomal cytarabine have shown similar efficacy and tolerability. We hypothesized that combination intrathecal chemotherapy would be a safe and tolerable option in solid tumor LM. We conducted a retrospective cohort study of combination IT chemotherapy in solid tumor LM at a single institution between April 2010 and July 2012. In addition to therapies directed at active systemic disease, each subject received IT liposomal cytarabine plus IT methotrexate with dexamethasone premedication. Patient characteristics, survival outcomes and toxicities were determined by systematic chart review. Thirty subjects were treated during the study period. The most common cancer types were breast 15 (50 %), glioblastoma 6 (20 %), and lung 5 (17 %). Cytologic clearance was achieved in 6 (33 %). Median non-glioblastoma overall survival was 30.2 weeks (n = 18; range 3.9-73.4), and did not differ significantly by tumor type. Median time to neurologic progression was 7 weeks (n = 8; range 0.9-57), with 10 subjects (56 %) experiencing death from systemic disease without progression of LM. Age less than 60 was associated with longer overall survival (p = 0.01). Six (21 %) experienced grade III toxicities during treatment, most commonly meningitis 2 (7 %). Combination IT chemotherapy was feasible in this small retrospective cohort. Prospective evaluation is necessary to determine tolerability, the impact on quality of life and neurocognitive outcomes or any survival benefit when compared to single agent IT chemotherapy. |
| Databáze: | OpenAIRE |
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