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Review

An overview of the therapeutic strategies for neoplastic meningitis due to breast cancer: when and why?

ORCID Icon, , , , , , , ORCID Icon, , , , & ORCID Icon show all
Pages 77-103 | Received 04 Oct 2023, Accepted 06 Dec 2023, Published online: 25 Dec 2023
 

ABSTRACT

Introduction

Neoplastic meningitis (NM), also known as leptomeningeal carcinomatosis, is characterized by the infiltration of tumor cells into the meninges, and poses a significant therapeutic challenge owing to its aggressive nature and limited treatment options. Breast cancer is a common cause of NM among solid tumors, further highlighting the urgent need to explore effective therapeutic strategies. This review aims to provide insights into the evolving landscape of NM therapy in breast cancer by collating existing research, evaluating current treatments, and identifying potential emerging therapeutic options.

Areas covered

This review explores the clinical features, therapeutic strategies, recent advances, and challenges of managing NM in patients with breast cancer. Its management includes multimodal strategies, including systemic and intrathecal chemotherapy, radiation therapy, and supportive care. This review also emphasizes targeted drug options and optimal drug concentrations, and discusses emerging therapies. Additionally, it highlights the variability in treatment outcomes and the potential of combination regimens to effectively manage NM in breast cancer.

Expert opinion

Challenges in treating NM include debates over clinical trial end points and the management of adverse effects. Drug resistance and low response rates are significant hurdles, particularly inHER2-negative breast cancer. The development of more precise and cost-effective medications with improved selectivity is crucial. Additionally, global efforts are needed for infrastructure development and cancer control considering the diverse nature of the disease.

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Abbreviations

PFS=

Progression free survival

JAK=

Janus Kinase

MTD=

Maximum Tolerated Dose

ORR=

Objective Response Rate

AE=

Adverse Events

DFS=

Disease Free Survival

DLT=

Dose Limiting Toxicity

MTX=

Methotrexate

NM=

Neoplastic meningitis

LM=

Leptomeningeal metastasis

BC=

Breast cancer

CNS=

Central Nervous System

CSF=

Cerebrospinal fluid

HDMTX=

High-dose methotrexate

OS=

Overall survival

IT=

Intrathecal chemotherapy

RT=

Radiation therapy

SC=

Systemic chemotherapy

MTX=

Methotrexate

IT Mtx=

intrathecal methotrexate

TNBC=

Triple-Negative Breast Cancer

BBB=

Blood Brain Barrier

RT=

Radiotherapy

LP=

Lumbar puncture

WBRT=

Whole-brain radiation therapy

SRS=

Stereotactic radiosurgery

SRT=

Stereotactic radiotherapy

Declaration of interest

MS Ahluwalia has received grants from Seagen and has consulted for Bayer, Novocure, Kiyatec, Insightec, GlaxoSmithKline, Xoft, Nuvation, Cellularity, SDP Oncology, Apollomics, Prelude, Janssen, Tocagen, Voyager Therapeutics, Viewray, Caris Lifesciences, Pyramid Biosciences, Varian Medical Systems, Cairn Therapeutics, Anheart Therapeutics, Theraguix, Menarini Ricerche, Sumitomo Pharma Oncology, Autem therapeutics, and GT Medical Technologies. M. S. Ahluwalia is also on Scientific Advisory Boards for Cairn Therapeutics, Pyramid Biosciences, Modifi Biosciences, and Bugworks and is a stock/shareholder with Mimivax, Cytodyn, MedInnovate Advisors LLC, and Trisalus Life Sciences. R Mahtani serves as a consultant/advisor for AstraZeneca, Daiichi Sankyo, Eisai, Genentech, Gilead Sciences, Hologic, Eli Lilly and Company, Merck and Co, Novartis, Pfizer, Puma, Sanofi, Seagen Inc, Sermonix and Stemline. All other authors have no relevant conflicts of interest to declare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.

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