title: Salvage intracerebrospinal fluid thiotepa in breast cancer-related leptomeningeal metastases: a retrospective case series.
abstract: There is currently a paucity of data on salvage intracerebrospinal fluid (intra-CSF) chemotherapy in leptomeningeal metastases (LM). This report is a single-institution experience with salvage treatment in patients with breast cancer (BC) and LM. This retrospective cohort describes 24 consecutive patients with BC selected for a second-line of treatment for LM. The first line of LM treatment consisted of intra-CSF liposomal cytarabine in all patients combined with systemic therapy in 18 cases and radiotherapy in four cases. Second-line (salvage) treatment utilized intra-CSF thiotepa in all and systemic chemotherapy in nine patients. No patient received CNS-directed radiotherapy. The median Eastern Cooperative Oncology Group performance status at initiation of intra-CSF thiotepa treatment was 3 (range 1-4). The median progression-free survival and median survival following intra-CSF thiotepa was 3.1 months (range 3 days-2 years) and 4.0 months (range 6 days-2.5 years), respectively. The median overall survival from LM diagnosis was 9.5 months (range 1.3 months-2.7 years). No grade 3 or higher toxicity was observed. Recognizing the limits of a retrospective study, intra-CSF thiotepa has an acceptable toxicity profile and appears to be a reasonable option for selected BC patients.
authors: aBreast Unit, Department of Medical Oncology Departments of bClinical Pharmacy cRadiology dPathology, Oscar Lambret Center eNeuro-oncology, Department of Neurosurgery fDepartment of Neurosurgery, Roger Salengro Hospital, University Hospital gDepartment of Biostatistics, University Hospital hUniversity of Lille Nord de France, Lille Departments of iRadiation Oncology jNeuro-oncology, Pitié-Salpétrière Hospital, Paris, France kDepartment of Neurology, Fred Hutchinson Cancer Research Center lNeuro-oncology Clinic, University of Washington, Seattle, Washington, USA.
authors: Emilie
authors: E
authors: Le Rhun
authors: Sophie
authors: S
authors: Taillibert
authors: Patrick
authors: P
authors: Devos
authors: Fahed
authors: F
authors: Zairi
authors: Anthony
authors: A
authors: Turpin
authors: Isabelle
authors: I
authors: Rodrigues
authors: Jean Louis
authors: JL
authors: Cazin
authors: Matthieu Faivre
authors: MF
authors: Pierret
authors: Charles
authors: C
authors: André
authors: François
authors: F
authors: Dubois
authors: Jacques
authors: J
authors: Bonneterre
authors: Marc C
authors: MC
authors: Chamberlain
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000556:secondary; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D013129:Spinal Puncture; D013852:Thiotepa / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000627:therapeutic use*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D013852:Thiotepa