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Systemic high-dose intravenous methotrexate for central nervous system metastases
Andrew B Lassman1, Lauren E Abrey, Gaurav D Shah
1Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Lassmana@mskcc.org
Journal of Neuro-Oncology
|December 14, 2005
Summary
High-dose intravenous methotrexate effectively treats central nervous system metastases, offering disease control in 56% of patients. This treatment shows promise for recurrent CNS metastases where options are limited.
Area of Science:
- Neuro-oncology
- Medical oncology
- Pharmacology
Background:
- Limited treatment options exist for recurrent central nervous system (CNS) metastases.
- High-dose intravenous methotrexate (HD IV MTX) can penetrate the blood-brain barrier (BBB).
- HD IV MTX has demonstrated activity in leptomeningeal metastases.
Purpose of the Study:
- To evaluate the efficacy and toxicity of HD IV MTX in patients with CNS metastases.
- To determine radiographic response rates and survival outcomes for HD IV MTX treatment.
Main Methods:
- Retrospective review of medical records for patients treated with HD IV MTX (3.5 g/m2) for CNS parenchymal or leptomeningeal metastases.
- Assessment of radiographic response, survival, and toxicity.
- Analysis of patient demographics and cancer types.
Main Results:
- Thirty-two patients (29 breast cancer, 1 CUP, 1 head and neck, 1 NSCLC) received 141 cycles of HD IV MTX.
- Objective radiographic response or stable disease was observed in 56% of assessable patients (9 response, 9 stable).
- Median overall survival was 19.9 weeks; common toxicities included myelosuppression (21%) and elevated transaminases (9%).
Conclusions:
- HD IV MTX demonstrates effectiveness in treating CNS metastases, achieving disease control in 56% of patients.
- The treatment is associated with manageable toxicities.
- Further investigation into HD IV MTX for CNS metastases is warranted.
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