Abstract Details

Title Standardized Intrathecal (IT) Treatment and Surveillance in Leptomeningeal Carcinomatosis (LMC) Improves Patient Outcomes: developing Ommaya IT chemotherapy clinics

Topic Neuro-oncology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-028

Objective

Not applicable

Background Leptomeningeal carcinomatosis (LMC), first described in 1870, involves leptomeningeal and CSF invasion by neoplastic cells and portends poor survival. Among solid tumor LMC, breast cancer is the most common followed by lung and melanoma. With an estimated 100,000+ new cases yearly, the dual-edged sword of systemic treatment drives the increasing incidence. As cancer patients live longer and on non-CNS penetrating therapies, tumor cells find sanctuary in the CNS. Multiple reports on the topic have not yielded consistent treatment standard to extend patient survival with minimal toxicity. Most agree that local CNS control coupled with systemic therapy offers the best survival. However, with few established Ommaya IT chemotherapy clinics (OITCC) reporting outcomes, data for patients on a standardized treatment and surveillance regimen are difficult to extrapolate.

Design/Methods

We report 21 CSF/radiographic LMC cases between 2017-2018 (breast 8; lung 3; hematologic 4; melanoma 3; other 3) all determined suitable for standardized OITCC treatment. This includes Ommaya placement, whole brain RT (WBRT) 20Gy, systemic therapy, and graduated IT chemotherapy treatments (2x weekly - every 8weeks), every 3mos MRI brain, and monthly provider clinical/lab examinations.

Results

The overall mOS (weeks) was 33. We evaluated patients with no IT treatment (NT) vs IT+; WBRT+IT (WIT) vs WBRT+IT+systemic (WITs). Addition of IT as compared to no IT led to 17.5-fold increase in mOS (2 vs 35). Addition of systemic therapy to WBRT+IT resulted in a 21-week improvement in survival (9 vs 35 respectively). No patients had relapsed LMC. Breast LMC fared better, was more common, and onset at 4.5-years after diagnosis. While melanoma and lung LMC onset after 1.5-years and fared worse.

Conclusions

Patients treated according to our OITCC regimen, independent of primary disease, experienced longer overall and progression-free survival rates (8-56+wk) compared to historical controls (4-24wks). Development of institutional OITCCs reduces treatment variability and increases disease surveillance.

Authors/Disclosures
Erika Leese, PA (Geisinger Medical Center) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Na Tosha N. Gatson, MD, PhD, FAAN	Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GT Medical Technologies. Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Menarini Silicon Biosystems. Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NuvOx Pharmaceuticals. Dr. Gatson has received publishing royalties from a publication relating to health care. Dr. Gatson has a non-compensated relationship as a Board Member with Society for Equity in Neurosciences (SEQUINS) that is relevant to AAN interests or activities.

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