Management of Leptomeningeal Metastasis in Patients with Lung Cancer

Abstract

445 ISSN 1758-1966 10.2217/LMT.13.55 © 2013 Future Medicine Ltd Lung Cancer Manage. (2013) 2(6), 445–447 Leptomeningeal metastasis (LM) is a rare complication of lung cancer. It occurs in approximately 1–6% of patients with lung cancer and it is most commonly associated with adenocarcinoma (50–56%), followed by squamous cell carcinoma (26–36%) and small cell carcinoma (13–14%) [1]. Lung cancer patients harboring activating mutations in EGFR are associated with prolonged disease control and survival when tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib are used. These improvements may contribute to a relative increase in the prevalence of LM from non-small-cell lung cancer (NSCLC), which is still a devastating complication associated with poor survival. Even with maximal therapy, average survival following the diagnosis of LM is less than 1 year [2]. The optimal therapeutic approach for LM remains challenging. Poor penetration of chemotherapeutic agents beyond the blood–brain barrier (BBB) is in part responsible for the limited therapeutic options for LM patients. LM patients are treated with various treatment methods: whole-brain and/or spinal cord irradiation, intrathecal chemotherapy (ITC), systemic chemotherapy and surgery. Nevertheless due to the small and heterogeneous population of LM patients, the relative benefits of these approaches remain poorly characterized. So in this editorial, recent topics and commentaries are provided regarding the management of LM from lung cancer with an emphasis on the treatment strategy.