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. 2023 Dec;26(6):572-581.
doi: 10.4048/jbc.2023.26.e40. Epub 2023 Sep 8.

Intrathecal Catheter for Chemotherapy in Leptomeningeal Carcinomatosis From HER2-Negative Metastatic Breast Cancer

Denis Dupoiron  1 , Lila Autier  2 , Nathalie Lebrec  3 , Valérie Seegers  4 , Caroline Folliard  5 , Anne Patsouris  2 , Mario Campone  2 , Paule Augereau  2
Affiliations

Intrathecal Catheter for Chemotherapy in Leptomeningeal Carcinomatosis From HER2-Negative Metastatic Breast Cancer

Denis Dupoiron et al. J Breast Cancer. 2023 Dec.

Abstract

Purpose: Most oncological treatments for leptomeningeal metastasis (LM) do not cross the blood-brain barrier (BBB). One therapeutic option is intrathecal (IT) chemotherapy. Both the brain-implanted Omaya reservoir and lumbar puncture (LP) are classic routes for IT chemotherapy delivery. An intrathecal catheter (IC) connected to a subcutaneous port is a recently developed option for the management of chemotherapy infusions. It is essential to evaluate the efficacy and safety of chemotherapy infusion using such device.

Methods: We conducted a retrospective monocentric study within Institut de cancerologie de l'Ouest at Angers, including all patients with advanced breast cancer (aBC) with LM implanted with an IT device for IT chemotherapy between January 2013 and May 2020. The primary endpoint was overall survival (OS) and secondary endpoints included surgical feasibility, patient safety, and progression-free survival (PFS). The catheter was inserted through an LP, the tip was positioned at the right level and connected to a subcutaneous port implanted under the skin of the anterior thoracic wall. IT chemotherapy is painless and easy for qualified nurses to administer on an outpatient basis.

Results: Thirty women underwent the implantation. No failures occurred during the procedure. A total of 77% of patients reported no complications after implantation. Only three complications required surgical treatment. The median number of IT chemotherapy courses per patient was 8 (range, 2-27). The tolerance profile for iterative IT chemotherapy was manageable in ambulatory care. With a median follow-up of 76.5 months (95% confidence interval [CI], 11.6-not available), the median OS was 158 days (95% CI, 87-235), and the median PFS was 116 days (95% CI, 58-174).

Conclusion: Infusing chemotherapy using an implanted catheter is an efficient option for managing IT chemotherapy with a good tolerance profile. Patient-reported outcomes for the evaluation of IT chemotherapy toxicity are currently being developed.

Keywords: Blood-Brain Barrier; Breast Neoplasms; Infusions, Spinal; Meningeal Carcinomatosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Surgical implantation of intrathecal catheter.
Figure 2
Figure 2. Magnetic resonance imaging of leptomeningeal carcinomatosis. (A) Cerebellar leptomeningeal meningitis. (B) Lumbar leptomeningeal meningitis.
Figure 3
Figure 3. Tolerance profile post catheter implantation.
Figure 4
Figure 4. Intrathecal chemotherapy courses per patient.
Figure 5
Figure 5. Overall survival in days.
See this image and copyright information in PMC

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