Abstract | BACKGROUND: A study was undertaken to determine whether route (intraventricular vs intralumbar) of intracerebrospinal fluid (intra-CSF) drug administration influences progression-free survival in the treatment of patients with neoplastic meningitis, which occurs in 1% to 5% of patients with known cancer. Currently available treatment options result in modest responses, which is in part a reflection of obstacles to drug delivery into the leptomeningeal space. METHODS: One hundred patients with clinically and cytologically or radiographically documented neoplastic meningitis because of solid cancers received intra-CSF liposomal cytarabine or methotrexate as specified in a randomized phase 4 trial. The 2 treatment arms were well balanced for demographic and tumor-related characteristics of known prognostic importance, including age, performance status, tumor type, extent of systemic and other central nervous system ( CNS) disease, prior CNS therapy, and concurrent systemic chemotherapy. RESULTS: One hundred patients were randomized and treated (52 with sustained-release cytarabine, and 48 with methotrexate). Progression-free survival (the primary study endpoint) was identical between the sustained-release cytarabine and methotrexate treatment arms for all 100 patients (35 vs 37.5 days, P = .79). When progression-free survival was examined as a function of route of chemotherapy administration (lumbar vs ventricular), there was no difference for patients treated with sustained-release cytarabine (29 vs 43 days, P = .35). For patients treated with methotrexate, however, there was a statistically significant difference favoring patients receiving intraventricular therapy (19 vs 43 days, P = .048). CONCLUSIONS:
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Authors | Michael J Glantz, Alixis Van Horn, Rebecca Fisher, Marc C Chamberlain |
Journal | Cancer
(Cancer)
Vol. 116
Issue 8
Pg. 1947-52
(Apr 15 2010)
ISSN: 0008-543X [Print] United States |
PMID | 20151421
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | (c) 2010 American Cancer Society. |
Chemical References |
- Delayed-Action Preparations
- Cytarabine
- Methotrexate
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Topics |
- Adult
- Cytarabine
(administration & dosage)
- Delayed-Action Preparations
(administration & dosage)
- Disease-Free Survival
- Humans
- Injections, Intraventricular
- Meningeal Carcinomatosis
(drug therapy)
- Meningitis
(drug therapy)
- Methotrexate
(administration & dosage)
- Neoplasms
(complications)
- Spinal Puncture
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