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Published on: May 23, 2025
Neoplastic meningitis from solid tumors: new diagnostic and therapeutic approaches
Giuseppe Lombardi1, Fable Zustovich, Patrizia Farina
1Medical Oncology 1 Unit, Istituto Oncologico Veneto–IRCCS, Padova, Italy. giuseppe.lombardi@ioveneto.it
Abstract:
Neoplastic meningitis is a result of the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid. This event occurs in 4%-15% of all patients with solid tumors and represents an important prognostic factor for poor survival. Neoplastic meningitis should be diagnosed in the early stages of disease to prevent important neurological deficits and to provide the most appropriate treatment. Despite new diagnostic approaches developed in recent years, such as positron emission tomography-computed tomography and new biological markers, the combination of magnetic resonance imaging without and with gadolinium enhancement and cytology still has the greatest diagnostic sensitivity. Recently, no new randomized studies comparing intrathecal (i.t.) with systemic treatment have been performed, yet there have been a few small phase II studies and case reports about new molecularly targeted substances whose successful i.t. or systemic application has been reported. Trastuzumab, gefitinib, and sorafenib are examples of possible future treatments for neoplastic meningitis, in order to better individualize therapy thus allowing better outcomes. In this review, we analyze the most recent and interesting developments on diagnostic and therapeutic approaches.
Insights
Neoplastic meningitis, a cancer spread to the brain's protective layers, requires early diagnosis for better outcomes. Advances in targeted therapies offer hope for improved treatment of this condition.
Area of Science:
- Neuro-oncology
- Medical diagnostics
- Clinical therapeutics
Background:
- Neoplastic meningitis occurs in 4%-15% of solid tumor patients, significantly worsening prognosis.
- Early diagnosis is crucial to prevent neurological deficits and guide treatment.
- It involves malignant cell spread to the leptomeninges and cerebrospinal fluid.
Purpose of the Study:
- To review recent advancements in diagnosing neoplastic meningitis.
- To analyze emerging therapeutic strategies for neoplastic meningitis.
- To discuss the potential of molecularly targeted agents in individualized treatment plans.
Main Methods:
- Review of recent literature on diagnostic and therapeutic approaches for neoplastic meningitis.
- Analysis of current diagnostic tools, including MRI with gadolinium enhancement and cytology.
- Examination of emerging targeted therapies and their reported efficacy.
Main Results:
- Magnetic resonance imaging (MRI) with gadolinium enhancement and cerebrospinal fluid cytology remain highly sensitive diagnostic methods.
- While no new large randomized trials exist, small studies suggest potential for molecularly targeted agents.
- Trastuzumab, gefitinib, and sorafenib show promise in case reports and phase II studies.
Conclusions:
- Integrated diagnostic approaches combining advanced imaging and cytology are key for early neoplastic meningitis detection.
- Molecularly targeted therapies represent a promising avenue for personalized treatment, potentially improving patient outcomes.
- Further research into novel agents and treatment strategies is warranted to optimize care for neoplastic meningitis.
