Response of Meningeal Carcinomatosis from Breast Cancer to Capecitabine Monotherapy: A Case Report

Abstract

A 62-year-old woman with breast cancer received neoadjuvant chemotherapy followed by breast-conserving surgery and sentinel node biopsy. During adjuvant endocrine therapy with aromatase inhibitor, she developed multiple bone metastases. Thereafter, she received tamoxifen and zoledronate therapy. In May 2011, she developed a tongue deviation and was diagnosed as having meningeal carcinomatosis. The tongue deviation disappeared 3 weeks after taking capecitabine (2,400 mg/day). Magnetic resonance imaging of the brain showed regression of meningeal carcinomatosis. Levels of tumor markers CEA and CA15-3 changed from 96.0 IU/ml and 3.5 ng/ml to 47.0 IU/ml and 1.5 ng/ml, respectively. Progression-free survival with capecitabine monotherapy was 5 months.

Durable clinical benefit of letrozole in leptomeningeal metastasis of breast cancer

“…Meningeal tumor deposits are well vascularized with highly permeable blood vessels. Treatment for these tumor deposits by cytostatic drugs through their own blood supply may be more effective than by superficial exposure to drugs dissolved in the CSF [13].…”

Neoplastic meningitis in solid tumors: from diagnosis to personalized treatments

“…Breast cancer is the most frequent cause of NM from solid tumors, with an estimated frequency of 3-5%. Capecitabine has shown long-lasting responses in NM in small case series, 105 and the use of an intensified regimen, such as metronomic schedule, has been proposed to treat NM from breast cancer, and is planned to be investigated in a larger phase II trial. 106 Amplification of HER2 is observed in 15-20% of patients with breast cancer.…”

Neoplastic Meningitis Due to Lung, Breast, and Melanoma Metastases

“…7 Breast Cancer: Capecitabine, a fluoropyrimidine that can penetrate the CNS, has shown durable responses in small case series of breast cancer-related neoplastic meningitis. 80,81 Taxane-based chemotherapies (paclitaxel and docetaxel, which are common agents used to treat breast cancer), do not cross the blood-CSF barrier and have no efficacy in treating neoplastic meningitis. 82 Responses in patients with neoplastic meningitis after endocrine therapy (tamoxifen, letrozole, anastrozole, megestrol) have occasionally been reported, but most often at the initial presentation of neoplastic meningitis.…”