Isolated leptomeningeal carcinomatosis (carcinomatous meningitis) after taxane-induced major remission in patients with advanced breast cancer.

Abstract

OBJECTIVES:

To identify the incidence of leptomeningeal carcinomatosis (LMC), as the first site of systemic progression, in breast cancer patients after having obtained a major response (CR or near CR) to first-line taxane-based chemotherapy and compare these findings in retrospect with a matched-pair group of historical control patients from our database treated with nontaxane regimens.

PATIENTS AND METHODS:

Patients with histologically proven breast cancer having either metastatic disease or high-risk locoregional disease that were entered into treatment protocols with first-line taxane (paclitaxel or docetaxel) plus anthracyclines or mitoxantrone combinations and developed LMC as the first evidence of progression after major response (CR or >80% PR) were analyzed in the present study (n = 155), and compared, as regards the incidence of LMC, to a matched-pair retrospective group of 155 patients treated with nontaxane regimens in our unit.

RESULTS:

Seven patients with a median age of 54 years (range 40-70) developed LMC as their first evidence of progression after taxane-based regimens with a median interval of 6 months (range 2-18) from start of treatment to diagnosis of LMC. Five patients received intrathecal (i.t.) methotrexate treatment and whole brain radiotherapy (RT), while 1 patient received i.t. methotrexate and RT to the lumbar spine. Two patients responded to treatment for LMC, while 2 achieved stable disease and 3 progressed. Two patients had elevated cerebrospinal fluid tumor markers (more than serum marker levels) that proved useful in monitoring response to treatment. Median survival after LMC was 3.6 months (range 1-17+) and correlated positively to the interval from the initiation of taxane-based therapy to LMC (r = 0.84, p = 0.019). Seven out of 86 responders (8.13%) in the taxane group versus 1 out of 72 responders (1.4%) in the non-taxane-treated group developed LMC as the first sign of progression after a major response to first-line chemotherapy (p < 0.1).

CONCLUSIONS:

LMC after a major response to front-line taxane-based regimens represents a grave disease manifestation and its incidence appears increased, but not significantly so, when compared retrospectively to non-taxane-treated patients. Prospective evaluation of the incidence of LMC after taxane versus non-taxane-based treatment from large randomized multi-institutional trials is warranted and identification of potential prognostic factors might help to identify patients requiring appropriate prophylactic therapy.

• Authors: Christos Kosmas, Nikolaos A Malamos, Nikolas B Tsavaris, Melina Stamataki, Achilleas Gregoriou, Sofia Rokana, Maria Vartholomeou, Minas J Antonopoulos
• Journal: Oncology (Oncology) Vol. 63 Issue 1 Pg. 6-15 ( 2002) ISSN: 0030-2414 [Print] Switzerland
• PMID: 12187065 (Publication Type: Clinical Trial, Comparative Study, Journal Article)
• Copyright: Copyright 2002 S. Karger AG, Basel

Chemical References

• Taxoids
• Docetaxel
• Paclitaxel
• Methotrexate

Topics

• Adult
• Aged
• Breast Neoplasms (complications, drug therapy)
• Combined Modality Therapy
• Disease Progression
• Docetaxel
• Female
• Humans
• Incidence
• Meningeal Neoplasms (chemically induced, chemistry, epidemiology, mortality, radiotherapy)
• Meningitis (ethnology)
• Methotrexate (adverse effects, therapeutic use)
• Middle Aged
• Neoplasm Staging
• Paclitaxel (adverse effects, analogs & derivatives)
• Prospective Studies
• Recurrence
• Remission Induction
• Survival Rate
• Taxoids