Case studies of patients receiving intraventricular topotecan for treatment of neoplastic meningitis.

Abstract

e12540 Background: As cancer patients experience longer survival times, the leptomeningies increasingly play host to metastatic disease from a variety of primary sources. The disease is known as lymphomatous meningitis, or carcinomatous meningitis, depending on the site of origin of the tumor. Generically, the disease can be called neoplastic meningitis (NM) or leptomeningeal metastasis. Sadly, NM frequently results in neurological and functional devastation in afflicted patients. Research into effective and well tolerated treatments is on the rise as the incidence of NM increases. Intrathecal and intraventricular (IVt) chemotherapy via an implanted ventricular reservoir is often administered in order to circumvent the blood-brain-barrier and blood-CSF-barrier, and to provide direct contact of drug with tumor cells. The use of IVt topotecan in the treatment of NM results in progression-free survival outcomes similar to other IVt chemotherapies, while being particularly well tolerated by most patients. Methods: We present case studies from 5 patients who received IVt topotecan for NM. Primary tumors in these patients were as follows: 2 patients with primary breast cancer, 1 patient with multiple myeloma, 1 patient with medulloblastoma and 1 patient with melanoma. Results: In this series of patients, 5 months was the minimum length of treatment with IVt topotecan and maximum length of treatment was 10 months. One patient continues to receive treatment after 7 months. One patient experienced fatigue which was well controlled with dexamethasone. One patient consistently experienced nausea the day after treatment which was well controlled with compazine. There were no other adverse effects. Reasons for stopping treatment were as follows. One patient had progressive systemic disease, 2 patients experienced progression of NM, 1 patient stopped due to progressive neurological and physical decline, one patient continues treatment at this time. Conclusions: Overall, we find IVt topotecan a well tolerated and viable treatment for patients with NM originating from a variety of primary malignancies. No significant financial relationships to disclose.