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ESMO Open. 2019 May 21;4(Suppl 2):e000507. doi: 10.1136/esmoopen-2019-000507. eCollection 2019.

How we treat patients with leptomeningeal metastases.

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CHU Lille, Neuro-Oncology, General and Stereotaxic Neurosurgery Service, and Neurology & Medical Oncology, Oscar Lambret Cancer Center, University of Lille, F-59000, Lille, France.
Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland.
Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
BrainTumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Radiation Oncology & BrainTumor Center, University Hospital and University of Zurich, Zurich, Switzerland.


The goal of treatment of leptomeningeal metastasis is to improve survival and to maintain quality of life by delaying neurological deterioration. Tumour-specific therapeutic options include intrathecal pharmacotherapy, systemic pharmacotherapy and focal radiotherapy. Recently, improvement of leptomeningeal disease-related progression-free survival by adding intrathecal liposomal cytarabine to systemic treatment versus systemic treatment alone has been observed in a randomised phase III trial for patients with breast cancer with newly diagnosed leptomeningeal metastasis. Safety and efficacy of intrathecal administration of new agents such as trastuzumab are under evaluation. Systemic therapy using targeted agents and immunotherapy has also improved outcome in patients with brain metastasis, and its emerging role in the management of leptomeningeal metastasis needs to better studied in prospective series. Focal radiotherapy is commonly indicated for the treatment of macroscopic disease such as meningeal nodules or clinically symptomatic central nervous system structures, for example, base of skull with cranial nerve involvement or cauda equine syndrome. The role of whole brain radiotherapy is decreasing. An individualised combination of different therapeutic options should be used considering the presentation of leptomeningeal metastasis, as well as the histological and molecular tumour characteristics, the presence of concomitant brain and systemic metastases, and prior cancer-directed treatments.


carcinomatous; cerebrospinal; chemotherapy; intrathecal; meningitis; radiotherapy; targeted

Conflict of interest statement

Competing interests: ELR has received research grants from Mundipharma and Amgen and honoraria for lectures or advisory board participation from Abbvie, Daiichi Sankyo, Mundipharma and Novartis. MP has received honoraria for lectures, consultation or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Merck Sharp & Dohme. MvdB has received research support from AbbVie and declares honoraria from Celgene, BMS, AbbVie, Agios and Boehringer Ingelheim. NA has received grants from Brainlab AG and personal fees from AstraZeneca. MW has received research grants from Abbvie, Adastra, Dracen, Merck, Sharp & Dohme (MSD), Merck (EMD), Novocure, OGD2, Piqur and Roche, and honoraria for lectures or advisory board participation or consulting from Abbvie, Basilea, Bristol Meyer Squibb, Celgene, Merck Sharp & Dohme (MSD), Merck (EMD), Novocure, Orbus, Roche and Tocagen.

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