Survival of a cohort of 25 breast cancer patients with neoplastic meningitis treated with intrathecal liposomal cytarabine

Abstract

1109 Background: Neoplastic meningitis (NM) occurs in 5% of the patients with breast cancer; if untreated the median duration of survival is 5 weeks. Combination of intrathecal (IT), systemic chemotherapy, and supportive care may increase overall survival (OS) to 5 months (Chamberlain, 2005). Methods: 30 consecutive female breast cancer patients diagnosed with NM, on the basis of cerebrospinal fluid (CSF) cytology and/or cerebrospinal MRI with clinical symptoms, have been prospectively treated for 19 months. Three patients did not receive any treatment because of a poor neurological status at diagnosis; 2 patients stopped treatment because of the lack of improvement after 1.5 months. The aim was to report clinico-pathological characteristics and OS in patients treated with IT liposomal cytarabine and supportive care with or without systemic chemotherapy. Statistical analyses were performed in the 25 treated patients. Correlations between tumor characteristics and OS were analyzed using usual statistical methods (Kaplan Meier, Log-rank, Cox). Results: Median age at NM diagnosis was 56 years. Median Karnofsky Performance Status (KPS) was 75. Breast cancers were invasive ductal carcinoma in 75%. Estrogen and progesterone receptors were detected in respectively 64 and 40%. HER-2 hyperexpression was observed in 33.5%. Tumors were triple negative in 17%. At the time of NM diagnosis CSF cytology and cerebrospinal MRI were positive in respectively 64% and 87.5%. Brain metastases were present in 64% of the patients, 36% had whole brain radiotherapy. Median delay between first symptoms and diagnosis was 16 days. Median delay between NM diagnosis and first IT was 17 days. Systemic chemotherapy was given in 56.5% at the discretion of the referring oncologist. All patients had supportive care. After 5 IT a clinical stabilization or improvement was observed in 56.5%. A CSF response was observed in 36%. Median OS of treated patients was 7 months. KPS at diagnosis (≥80), neurological status after 5 IT were significantly correlated with OS. A trend was also observed between association with systemic chemotherapy and OS. Conclusions: Our results confirm that the association of IT, systemic treatment and supportive care treatment may be useful in treating this cancer complication. No significant financial relationships to disclose.