Τίτλος:
Leptomeningeal carcinomatosis after major remission to taxane-based
front-line therapy in patients with advanced breast cancer
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aim: To determine the incidence of leptomeningeal carcinomatosis (LMC),
as the first manifestation of systemic progression, in breast cancer
patients after obtaining a major response (complete response, CR or
>80% partial response, PR) to first-line taxane-based chemotherapy
treated between 1996 and 2000 in our Medical Oncology Unit.
Patients and methods: Patients with histologically proven breast cancer
having either metastatic disease, or high-risk locoregional disease that
were entered into treatment protocols with first-line taxane (paclitaxel
or docetaxel) plus anthracyclines or mitoxantrone combinations and
developed LMC as the first evidence of progression after major response
(CR or >80% PR) were analyzed in the present study (n=155).
Results: Seven patients with a median age of 54 (range: 40-70) years
developed LMC as their first evidence of progression after taxane-based
regimens with a median interval of 6 months (range: 2-18) from start of
treatment to diagnosis of LMC. Five patients received intrathecal (i.t.)
methotrexate treatment and whole brain radiotherapy (RT), while one
patient received i.t. methotrexate and RT to lumbar spine. Two patients
responded to treatment for LMC, while two achieved stable disease and
three progressed. Two patients had elevated cerebrospinal fluid tumor
markers (more than serum marker levels) that proved useful in monitoring
response to treatment. Median survival after LMC was 3.6 months (range:
1-31+) and correlated positively to the interval from the initiation of
taxane-based therapy to LMC (r=0.84, P=0.019). Seven out of 86
responders (8.1%; 95% confidence interval, 2.4-13.9) developed LMC as
the first sign of progression after a major response to first-line
chemotherapy.
Conclusions: LMC after a major response to front-line taxane-based
regimens represents a grave disease manifestation and its incidence
appears increased when compared in retrospect to non-taxane-treated
patients. Prospective evaluation of the incidence of LMC after taxane
versus non-taxane-based treatment from large randomized
multi-institutional trials is warranted and identification of potential
prognostic factors might help identify patients requiring appropriate
prophylactic therapy.
Συγγραφείς:
Kosmas, C
Malamos, NA
Tsavaris, NB
Stamataki, M and
Stefanou, S
Gregoriou, A
Rokana, S
Vartholomeou, M and
Antonopoulos, MJ
Περιοδικό:
Journal of Neuro-Oncology
Εκδότης:
KLUWER ACADEMIC PUBL
Λέξεις-κλειδιά:
leptomeningeal carcinomatosis; carcinomatous meningitis; paclitaxel;
docetaxel; breast cancer
DOI:
10.1023/A:1015018808804
