Prolonged survival of neoplastic meningitis from breast cancer with letrozole and intrathecal methotrexate: a case report

Abstract

Neoplastic meningitis from breast cancer has a dismal prognosis and short survival. Treatment is based on the intrathecal administration of chemotherapeutic agents, cranial or craniospinal radiotherapy, and systemic chemotherapy. In this report we describe the case of a woman with neoplastic meningitis from breast carcinoma who developed an excellent response to letrozole combined with intrathecal methotrexate, resulting in long-term survival of more than 36 months. Based on the findings of this case report, we suggest that addition of letrozole to the standard therapeutic approach may be beneficial for some patients.

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

“…In this review we have gathered data showing that subsets of patients have almost double the median OS in BC-LMD [12,45] and that use of ET in LMD can achieve prolonged survival rates compared with the usual reported outcomes [46,47,[58][59][60][61][62][63][64]74]. Our statistical comparison showed significant differences between OS LMD, suggesting that risk stratification could help identifying the most suitable patients for ET.…”

“…We found nine clinical cases reporting 12 women with BC-LMD treated ET (Table 2) [46,47,[58][59][60][61][62][63][64]. Nine patients received multimodality treatment after LMD diagnosis in addition to ET, RT (7), ITT (4) and chemotherapy (5).…”

Prolonged Regression of Metastatic Leptomeningeal Breast Cancer That Has Failed Conventional Therapy: A Case Report and Review of the Literature

“…Limited data exist for intrathecal use of hormonal therapy, though one case report by Peroukides et al [6] illustrates long-term survival in a patient with leptomeningeal metastases of ER/PR positive, HER2 negative invasive ductal breast adenocarcinoma treated with intrathecal letrozole. A case report by Ferrario et al [7] demonstrates the potential of intrathecal trastuzumab with breast cancer CNS metastases with reported survival more than 6 years from time of first dose.…”

Durable clinical benefit of letrozole in leptomeningeal metastasis of breast cancer

“…Demonstration of malignant cells in the CSF is needed to make a definitive diagnosis. Positive cytology is found in only 50% of patients with LM on the initial CSF analysis, and the probability of the diagnosis increases to 85% with three or more CSF analyses [5]. Thus, careful assessment is required to diagnose LM.…”

“…There are several published reports of successful treatment of LM with hormone therapies such as tamoxifen, letrozole, and exemestane [2, 5, 6, 8, 14–16]. Tamoxifen is a selective estrogen receptor modulator that is a highly lipophilic agent and can presumably cross the BBB easily [7].…”