Breast leptomeningeal disease: a review of current practices and updates on management

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

“…Only a few prospective ongoing studies are dedicated to the use of ET in luminal ABC-LMD, and most of them are in BC patients with CNS metastasis, and LMD patients with stable disease were not excluded [ 7 , 66 ]. Less than a handful are with newer ET agents (Z-endoxifen or elacestrant), and the majority are with ET combined with other agents such as the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib; PI3K inhibitors; the mTOR inhibitor everolimus; VEGFR inhibitors cabozantinib and lenvantinib; and IGF receptor antibodies (xentuzumab and BMS-754807) [ 7 , 66 ].…”

“…The blood–brain barrier (BBB) is cited as the principal factor for the limited CNS activity of most therapeutic regimens [ 26 ], but several authors suggest that in the presence of brain metastasis, the integrity of the BBB has been compromised, which could explain the survival benefit provided by SACT [ 30 , 31 ]. Furthermore, LMD itself has been shown to increase BBB permeability [ 7 ], and these patients are often subjected to whole-brain RT, which disrupts BBB organization and consequently increases concentration of systemic agents in CSF [ 7 , 31 ].…”

“…These are the principles of ITT that have been the mainstay for BC-LMD treatment in most European centers [ 17 ], yet its value is not well established [ 32 ]. Furthermore, its use is not recommended in the presence of hydrocephalus (because, due to impaired CSF flow, it augments the risk of neurotoxicity, furthering intracranial pressure and consequently brain herniation and ischemia) [ 4 , 22 , 33 ] or nodular disease only (due to limited diffusion of ITT agents into the subependymal tissue) [ 1 , 7 , 24 , 34 ]. ITT also involves invasive procedures and has possible serious adverse effects [ 24 , 29 , 35 ], even if it seems not to negatively affect quality of life [ 25 , 32 ].…”

Miliary breast cancer brain metastasis: a rare and aggressive form of central nervous system metastasis

“…6 Leptomeningeal metastasis is understood to be a unique subset of CNS metastasis with exceedingly poor survival, with distinctive characteristics, prognosis and management. 16 While the current understanding is limited, it is possible that MiM may represent a unique clinical entity with important distinctions. In the pursuit of a better understanding of the pathogenesis and potential treatment options of MiM, the objective imaging diagnostic criteria proposed by Bashour et al 11 are an important first step.…”

New Frontiers in Diagnosis and Therapy of Circulating Tumor Markers in Cerebrospinal Fluid In Vitro and In Vivo

“…Leptomeningeal and brain metastasis (LM and BM) as a result of metastatic dissemination of solid tumors (e.g., melanoma, breast cancer, lung cancer and colorectal cancer) and hematological neoplasms as well as primary brain tumors (BTs, e.g., glioma) are commonly fatal with minimum treatment options [1,2,3,4,5,6,7,8,9,10,11]. Relatively high number of underdiagnosed LM, BM and BT and often ineffective therapy are the major challenges.…”