Neoplastic Meningitis Due to Lung, Breast, and Melanoma Metastases

Emilie Le Rhun, MD; Sophie Taillibert, MD; Marc C. Chamberlain, MD

Disclosures

Cancer Control. 2017;24(1):22-32. 

In This Article

Conclusions

The incidence of neoplastic meningitis is increasing due to an improvement in the overall survival rate of patients with cancer, which, in part, reflects the fact that more effective anticancer therapies do not cross the brain–cerebrospinal fluid (CSF) barrier.[2,3] The diagnosis of neoplastic meningitis remains challenging, as reflected by its underdiagnosis and the limited sensitivity of CSF cytology and neuraxis radiography in establishing the diagnosis. Without treatment, neoplastic meningitis is associated with poor outcomes and progressive, neurological death. Determining which patients with neoplastic meningitis are likely to benefit from directed therapy is challenging; however, the extent of systemic disease, type of treatment, the neurological presentation, and the disease burden are all factors identified as being useful for proper patient selection. Treatment options can include chemotherapy (systemic and intra-CSF administration), site-specific radiotherapy, and symptom-directed care. Limited case reports suggest that immunotherapy and cancer-specific targeted therapies may be effective in the treatment of neoplastic meningitis in certain patients — and prospective studies are testing this hypothesis. Proposals for assessing treatment response in neoplastic meningitis could help to standardize the evaluation of neoplastic meningitis and improve clinical trial design so as to better define the role of novel therapies in neoplastic meningitis.

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