CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(01): 59-67
DOI: 10.1055/a-2185-0457
GebFra Science
Review

Intrathecal Therapy Options for Meningeal Carcinomatosis

Artikel in mehreren Sprachen: English | deutsch
Madeleine Marowsky
1   Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Volkmar Müller
1   Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Barbara Schmalfeldt
1   Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Kerstin Riecke
1   Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Isabell Witzel
2   Klinik für Gynäkologie, Universitätsspital Zürich, Universität Zürich, Zürich, Switzerland (Ringgold ID: RIN27243)
,
Elena Laakmann
1   Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
› Institutsangaben

Abstract

Around 5 percent of all patients with metastatic breast cancer go on to develop distant metastases in the meninges, also known as meningeal carcinomatosis. The median survival of these patients is between 3.5 and 4.5 months. Current treatment approaches are based on radiotherapy, systemic and intrathecal therapy. Methotrexate, liposomal cytarabine and trastuzumab are the most common substances used for intrathecal therapy. The aim of this review was to provide an overview of these intrathecal therapy options for meningeal carcinomatosis. A systematic search of the literature was carried out in PubMed using the following search terms: “meningeal metastases”, “meningeal carcinomatosis”, “leptomeningeal metastasis”, “leptomeningeal carcinomatosis”, “leptomeningeal disease”, “breast cancer”, “MTX”, “methotrexate”, “DepoCyte”, “liposomal cytarabine”, “trastuzumab” and “anti-HER2”. This search resulted in 75 potentially relevant studies, 11 of which were included in this review after meeting the previously determined inclusion and exclusion criteria. The studies differ considerably with regards to study design, cohort size, and dosages of administered drugs. In principle, intrathecal therapy has a tolerable side-effects profile and offers promising results in terms of the median overall survival following treatment with trastuzumab for HER2-positive primary tumors. The focus when treating meningeal carcinomatosis must be on providing a multimodal individual therapeutic approach. However, comprehensive studies which compare the efficacy and side effects of individual pharmaceuticals are lacking. Because of the poor prognosis associated with meningeal carcinomatosis, an approach which treats only the symptoms (best supportive care) should always be considered and discussed with affected patients.



Publikationsverlauf

Eingereicht: 27. August 2023

Angenommen nach Revision: 29. September 2023

Artikel online veröffentlicht:
08. November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany