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Review
. 2017 Feb 28:18:208-211.
doi: 10.12659/ajcr.901812.

Metronomic Capecitabine Effectively Blocks Leptomeningeal Carcinomatosis From Breast Cancer: A Case Report and Literature Review

Michela Maur  1 , Claudia Omarini  1 , Federico Piacentini  1 , Annalisa Fontana  1 , Elisa Pettorelli  1 , Stefano Cascinu  1
Affiliations
Review

Metronomic Capecitabine Effectively Blocks Leptomeningeal Carcinomatosis From Breast Cancer: A Case Report and Literature Review

Michela Maur et al. Am J Case Rep. .

Abstract

BACKGROUND Meningeal carcinomatosis is a rare complication in breast cancer patients. At present, there are no defined guidelines for its management. The efficacy of systemic treatment seems to depend on its ability to cross the blood-brain-barrier and its interaction with tumor vasculature. Metronomic chemotherapy is a known modality of drug administration able to inhibit tumor angiogenesis. CASE REPORT We present a case of symptomatic leptomeningeal carcinomatosis from breast cancer successfully treated with capecitabine. Based on the hypothesis that angiogenesis contributes to neoplastic meningitis, the patient was treated with a metronomic schedule that provided long-term clinical benefit with a very low toxicity profile. CONCLUSIONS To assess the real impact of metronomic chemotherapy in patients with meninges involvement, a phase II study will be starting soon in our institution. A review of the literature concerning the management of meningeal carcinomatosis is also presented.

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Conflict of interest statement

Conflict of interest: None declared

Disclosure

The authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
(A) The contrast-enhanced T1-weighted MRI shows multiple and diffuse bone metastatic lesions that infiltrate dural tissue into the subarachnoid space. Thickened and irregular enhancement with surrounding edema is seen along frontal, left, and right parietal lobes. (B) Flair (fluid attenuated inversion-recovery) shows the erosive changes of the cortical margins of the cranial bone with masses involving the subarachnoid space.
Figure 2.
Figure 2.
(A, B) The brain MRI performed after 6 months of metronomic capecitabine, confirming the diffuse bone and meningeal disease involvement, and showing initial response to the treatment and reduction in tumor vasculature.
See this image and copyright information in PMC

References

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