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Intraventricular topotecan for the treatment of neoplastic meningitis: five case studies
Julie Walker1, Diana Schultz1, Kathleen Grisdale1
1The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract:
Many systemic cytotoxic agents cannot penetrate the blood-brain barrier. Because of this, in approximately 5% of cancer cases, metastatic disease is seen in the leptomeninges. Without treatment, patients with neoplastic meningitis (NM) generally survive for only a matter of weeks. In the treatment of NM, intraventricular (IVT) topotecan results in progression-free and overall survival outcomes similar to those seen with other IVT chemotherapies, while being particularly well tolerated by most patients. In this article, we present the case studies of five patients with NM, with various primary malignancies, who received treatment with IVT topotecan.
Insights
Intraventricular topotecan offers effective treatment for neoplastic meningitis (NM), a rare cancer complication. This chemotherapy is well-tolerated and shows outcomes comparable to other treatments for leptomeningeal metastasis.
Area of Science:
- Neuro-oncology
- Pharmacology
Background:
- Systemic chemotherapy often fails to cross the blood-brain barrier, leading to leptomeningeal metastasis in 5% of cancer cases.
- Neoplastic meningitis (NM) has a poor prognosis, with survival typically measured in weeks without intervention.
Observation:
- Intraventricular (IVT) topotecan was administered to five patients with NM and diverse primary cancers.
- Case studies detail the treatment experience and outcomes for these patients.
Findings:
- IVT topotecan demonstrated progression-free and overall survival outcomes similar to existing IVT chemotherapies.
- The treatment was generally well-tolerated by the majority of patients.
Implications:
- Intraventricular topotecan presents a viable and tolerable therapeutic option for managing neoplastic meningitis.
- Further research into IVT topotecan may expand treatment strategies for leptomeningeal carcinomatosis.
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