SHARE Metastatic Breast Cancer

Leptomeningeal carcinomatosis

I am new to this community. A friend in India wrote me this message today. Any help or information I can give him would be appreciated.

'This is about my niece, she had received 4 doses of Keytruda, this was after 3-4 rounds of chemotherapy and one of radiotherapy. The dr today told us of what he says is not such a good news, she has developed a condition called leptomeningeal carcinomatosis, I will really appreciate your news and views on way out of this, if there is any medicine lately being used for this or is it mainly steroids and cranial radiation to stabilise the condition. Also, if anything can be given for reverse, undo this situation.'

Thank you in advance for any information.

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I have no experience with keytruda or brain Mets. Sorry I can't help you. All the best to your niece.

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Never give up hope. In rare cases, some patients with certain types of cancer that get carcinomatous meningitis can live years with appropriate treatment.

Systemic chemotherapy for LMC has been limited as effective CSF concentration can hardly be achieved except high dose methotrexate (MTX) intravenous administration. However, the introduction of small molecular weight target inhibitors for primary cancer treatment has changed the old concept of 'blood-brain barrier' as the ultimate barrier to systemically administered drugs. Conventional oral administration achieves an effective concentration at the nanomolar level. Furthermore, many studies report that a combined treatment of target inhibitor and intra-CSF chemotherapy significantly prolongs patient survival. Ventriculolumbar perfusion (VLP) chemotherapy has sought to increase drug delivery to the subarachnoid CSF space even in patients with disturbed CSF flow. Recently authors performed phase 1 and 2 clinical trial of VLP chemotherapy with MTX, and 3/4th of patients with increased ICP got controlled ICP and the survival was prolonged. Further trials are required with newly available drugs for CSF chemotherapy. Additionally, new LMC biologic/pharmacodynamic markers for early diagnosis and monitoring of the treatment response are to be identified with the help of advanced molecular biology techniques.

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