Long-Term Clinical Response in Leptomeningeal Metastases from Breast Cancer Treated with Capecitabine Monotherapy: A Case Report

Tham, Yee Lu; Hinckley, Lisa K.; Teh, Bin S.; Elledge, Richard M.

doi:10.3816/cbc.2006.n.028

Cited by 52 publications

(23 citation statements)

References 13 publications

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“…Therefore, in patients with methotrexate-sensitive cancers (lymphoma and breast cancer), high-dose methotrexate is a rational treatment for patients with combined brain parenchymal metastases and NM. Similarly, there are case reports suggesting that, in breast cancer patients with combined brain parenchymal metastases and NM, oral capecitabine may be effective as well [77][78][79]. Finally, a recent report describes two patients with breast cancer in whom NM was controlled with systemic hormonal treatment [80].…”

Section: Chemotherapymentioning

confidence: 99%

Neoplastic Meningitis

2008

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After completing this course, the reader should be able to:1. Describe the epidemiology of leptomeningeal metastasis.2. Participate in the diagnosis of leptomeningeal metastasis. Engage in the treatment of leptomeningeal metastasis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground: Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer.Methods: Notwithstanding frequent focal signs and symptoms, NM is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments.Results: Central nervous system staging of NM includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging or computerized tomographic myelography and radionuclide CSF flow study. Treatment of NM incorporates involved-field radiotherapy of bulky or

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Section: Chemotherapymentioning

confidence: 99%

Neoplastic Meningitis

2008

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“…This confirms the role of the CNS as a sanctuary site for breast cancer micrometastasis and reflects the limited penetration ability of most chemotherapy drugs across the blood brain barrier. There is some anecdotal evidence, however, suggesting that capecitabine (a 5-FU prodrug) may actually cross the blood brain barrier as evidenced by case reports of activity in patients with metastatic breast cancer to the brain [10,11].…”

Section: Discussionmentioning

confidence: 96%

Resolution of extensive leptomeningeal metastasis and clinical spinal cord compression from breast cancer using weekly docetaxel chemotherapy

Wilson

Sapp

Abdeen

et al. 2011

Breast Cancer Res Treat

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Metastatic breast cancer to the leptomeninges is a late event in the disease course and is associated with significant morbidity and a grave prognosis. Treatment typically involves direct intrathecal injection of chemotherapy into the cerebrospinal fluid compartment since systemic chemotherapy penetrates poorly to the central nervous system. Here we report an interesting clinical observation involving a patient presenting with leptomeningeal spread of breast cancer causing extensive spinal cord compression with obliteration of the subarachnoid space, thus precluding the use of direct intrathecal chemotherapy. We administered systemic chemotherapy using weekly docetaxel with complete radiographic resolution of her disease and recovery from clinical spinal cord compression. While this is a single clinical observation, weekly administration of docetaxel in this circumstance may have been associated with improved drug "escape" into the central nervous system and better antitumor effect. Because leptomeningeal disease is typically a late event in metastatic breast cancer, resistance to therapeutic intervention may reflect intrinsically resistant disease in the setting of extensive prior therapy rather than a routine problem with systemic drug delivery to the CNS. Studying patterns of disease relapse in patients who had received adjuvant weekly taxanes may provide insights into this hypothesis.

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“…A randomized trial comparing intrathecal DepoCyt R (a slow-release formulation of cytarabine) with intrathecal methotrexate in patients with neoplastic meningitis due to breast cancer showed similar response rates and a significantly greater time to neurological progression (58 vs. 30 days) [14]. However, intrathecal chemotherapy is known to cause acute and late side effects, such as chemical meningitis, leukoencephalopathy, and myelopathy, especially in patients who have previously received radiations [5]. As per a report about 70% of patients experienced complications associated with intrathecal chemotherapy [15].…”

Section: Discussionmentioning

confidence: 98%

“…Although a few reports have shown that capecitabine monotherapy is well tolerated and highly effective as a systemic chemotherapeutic regimen for the treatment of LM from breast cancer [4,5], there have been no reports evaluating combination therapy with trastuzumab and capecitabine. We report a case of LM from breast cancer in which the spinal symptoms were successfully controlled for 10 months with trastuzumab and capecitabine without any severe side effects.…”

Section: Introductionmentioning

confidence: 97%

Successful treatment of leptomeningeal metastases from breast cancer using the combination of trastuzumab and capecitabine: a case report

et al. 2008

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We report a case of metastatic breast cancer with leptomeninges and multiple bone metastases that showed an excellent response to the combination of trastuzumab and capecitabine; therapeutic effect was evaluated by MRI at follow-up. A 44-year-old woman underwent modified radical mastectomy in February 1997. In April 2003, a tumor at the right basis cerebri and multiple bone metastases were noted, and in October 2003, she underwent enucleation of the tumor. Histopathologically, the tumor was consistent with a basal skull metastasis from breast cancer. In March 2004, the patient began to experience pain, weakness, and paresthesia of both legs. She was diagnosed, with leptomeningeal metastasis (LM) from breast cancer using MRI. In December 2005, the combination of trastuzumab and capecitabine administered as sixth-line treatment was very effective for LM. Although it is generally very difficult to diagnose LM and assess the therapeutic effect with MRI, in this case, it was possible. To our knowledge, there has been no report in the literature describing the combination of trastuzumab and capecitabine for LM from breast cancer. Although the mechanism underlying the efficacy of this combination is still unknown, the treatment would be worth trying because of its few side effects in extensively treated patients with LM from breast cancer. To confirm the antitumor efficacy of trastuzumab and capecitabine, however, further investigations are required.

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Long-Term Clinical Response in Leptomeningeal Metastases from Breast Cancer Treated with Capecitabine Monotherapy: A Case Report

Cited by 52 publications

References 13 publications

Neoplastic Meningitis

Neoplastic Meningitis

Resolution of extensive leptomeningeal metastasis and clinical spinal cord compression from breast cancer using weekly docetaxel chemotherapy

Successful treatment of leptomeningeal metastases from breast cancer using the combination of trastuzumab and capecitabine: a case report

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