Format

Send to

Choose Destination
See comment in PubMed Commons below
Clin Lung Cancer. 2014 May;15(3):202-6. doi: 10.1016/j.cllc.2013.12.009. Epub 2014 Jan 1.

Prolonged survival of patients with non-small-cell lung cancer with leptomeningeal carcinomatosis in the modern treatment era.

Author information

1
Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Internal Medicine, University of California Davis School of Medicine; Division of Hematology/Oncology, University of California Davis Cancer Center, Sacramento, CA. Electronic address: jonathan.riess@ucdmc.ucdavis.edu.
2
Division of Neuro-Oncology, Department of Neurology, Stanford University School of Medicine, Stanford, CA.
3
Department of Radiology, Stanford University School of Medicine, Stanford, CA.
4
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA.
5
Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.

Abstract

INTRODUCTION:

Leptomeningeal carcinomatosis (LM) is a severe complication of non-small-cell lung cancer (NSCLC) historically associated with poor prognosis. New chemotherapeutic and targeted treatments could potentially affect the natural history of LM.

PATIENTS AND METHODS:

Patients with a pathologic diagnosis of NSCLC with LM treated at Stanford between 2003 and 2011 were identified via institutional databases and medical records. LM was defined by cerebrospinal fluid (CSF) that was positive for malignant cells or by LM enhancement on magnetic resonance imaging with gadolinium contrast. Retrospective, landmark analyses were performed to estimate survival. Statistical analyses were performed using SAS Enterprise Guide, version 4.3.

RESULTS:

LM was identified in 30 patients. All cases were adenocarcinoma; 60% of patients had a known or suspected driver mutation. The mean age was 58 years. Of the 30 patients, 67% were women; 70% were nonsmokers; 27% initially presented with LM; 84% received systemic treatment at or after development of LM; and 53% of these patients received modern systemic therapy for their LM, defined as a regimen containing pemetrexed, bevacizumab, or a tyrosine kinase inhibitor. Mean overall survival after LM diagnosis was 6 months (95% CI, 3-12). Patients who received modern systemic therapy for LM had decreased hazard of death (hazard ratio [HR], 0.24; P = .007).

CONCLUSION:

In this retrospective, single-institution analysis, median survival with LM was higher compared with historical experience. Patients who received modern systemic therapy for their LM had particularly good outcomes. These data provide evidence for improving survival outcomes in the modern treatment era for this difficult-to-treat complication.

KEYWORDS:

CNS disease; Chemotherapy; Leptomeningeal carcinomatosis; NSCLC; Targeted therapy

PMID:
24524822
DOI:
10.1016/j.cllc.2013.12.009
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center