Abstract
Many systemic cytotoxic agents cannot penetrate the blood-brain barrier. Because of this, in approximately 5% of cancer cases, metastatic disease is seen in the leptomeninges. Without treatment, patients with neoplastic meningitis (NM) generally survive for only a matter of weeks. In the treatment of NM, intraventricular (IVT) topotecan results in progression-free and overall survival outcomes similar to those seen with other IVT chemotherapies, while being particularly well tolerated by most patients. In this article, we present the case studies of five patients with NM, with various primary malignancies, who received treatment with IVT topotecan.
Highlights
As patients experience longer survival times with chronic malignancies, the leptomeninges may increasingly play host to metastatic disease from a variety of primary cancers. This occurs in approximately 5% of cancer cases (Chamberlain, 2008); due to the inability of many systemic cytotoxic agents to penetrate the blood-brain barrier, the leptomeninges can become a sanctuary for a number of metastatic malignancies (Groves et al, 2008)
We found that IVT topotecan was well tolerated with few symptoms of arachnoiditis, making it a viable treatment for patients with neoplastic meningitis (NM) originating from a variety of primary tumor sites
A 56-year-old man who was diagnosed with a primary cancer of multiple myeloma in January 2006 presented with lethargy, headache, weakness, and seizures
Summary
As patients experience longer survival times with chronic malignancies, the leptomeninges (arachnoid and pia mater) may increasingly play host to metastatic disease from a variety of primary cancers. Presented here are case studies from five patients who received IVT topotecan for NM. We found that IVT topotecan was well tolerated with few symptoms of arachnoiditis, making it a viable treatment for patients with NM originating from a variety of primary tumor sites. The patient experienced arachnoiditis symptoms while on topotecan, including gait ataxia, confusion, and slurred speech, but he received no special interventions.
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