Phase II Study of Systemic High-dose Methotrexate and Intrathecal Liposomal Cytarabine for Treatment of Leptomeningeal Carcinomatosis From Breast Cancer |
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| Authors: | Maciej M. Mrugala Bryan Kim Akanksha Sharma Natalie Johnson Carrie Graham Brenda F. Kurland Julie Gralow |
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| Affiliation: | 1. Comprehensive Neuro-Oncology Program, Department of Neurology, Mayo Clinic Cancer Center, Phoenix, AZ;2. Department of Neurology, University of Washington Medical School, Seattle, WA;3. Neuro-Oncology Program, Mayo Clinic Arizona, Phoenix, AZ;4. Seattle Cancer Care Alliance, Seattle, WA;5. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA;6. Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA |
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| Abstract: | Metastatic breast cancer frequently leads to brain metastases and, less commonly, leptomeningeal carcinomatosis (LC). Once cerebrospinal fluid involvement occurs, the prognosis is poor. There are limited treatment options available, but none offer significant survival benefit. Methotrexate, given systemically at high doses (3.5-8 gm/m2), achieves cytotoxic concentrations in the CSF and has been shown to prolong survival in patients with LC. Intrathecal liposomal cytarabine has been shown to increase time to neurologic progression in patients with breast cancer and LC. The combination of these 2 agents in LC has not been studied extensively. Here, we present the results of the phase II study with this combination showing promising efficacy and very good tolerability. |
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| Keywords: | Address for correspondence: Maciej M. Mrugala, MD, PhD, MPH, Neuro-Oncology Program, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 Breast cancer metastasis High-dose methotrexate Intrathecal chemotherapy Leptomeningeal carcinomatosis Liposomal cytarabine |
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