Long-Term Clinical Response in Leptomeningeal Metastases from Breast Cancer Treated with Capecitabine Monotherapy: A Case Report
ABSTRACT Brain and leptomeningeal metastases from breast cancer carry a poor prognosis and are often less responsive to systemic therapy. It is often thought that systemic therapy has a minimal role in the management of central nervous system (CNS) metastases because of the impermeability of the blood-brain barrier. However, treatments directed to the CNS such as radiation or intrathecal chemotherapy are not effective in managing concurrent non-CNS metastases. We report the long-term control of a woman receiving capecitabine with brain and leptomeningeal metastases. After 3.7 years of capecitabine therapy after whole-brain radiation, the patient remains without neurologic symptoms or deficits, has no evidence of disease on neuroimaging studies, but has a persistent positive cytology. This case report demonstrates that, in principle, systemic therapy can provide long-term complete responses for some patients with CNS metastases. The significance of persistent circulating tumor cells in the CNS in patients without evidence of disease is unclear but should be investigated further.
Article: Leptomeningeal Metastases[Show abstract] [Hide abstract]
ABSTRACT: Leptomeningeal metastases typically have been a rare complication of systemic cancers. The incidence is increasing for cancers of the breast and lung, primarily because of more effective treatment modalities and longer survival. Presentation consists of multiple symptoms related to areas in the central nervous system, including the brain, cranial nerves, and spinal nerve roots. Diagnosis is made by magnetic resonance imaging with contrast enhancement and cerebral spinal fluid pathology. Treatment frequently involves combination therapy with radiation and intrathecal chemotherapy. Outcomes are poor, with short survival of six weeks to six months. Nurses play a key role in the care of patients with leptomeningeal metastases. Nursing care for this patient population includes baseline assessment and monitoring for changes in central nervous system function, symptom management, chemotherapy administration, education about the disease and treatment, identification of psychosocial issues, and assessment of coping strategies of patients and families.Clinical journal of oncology nursing 03/2003; 7(2):151-5. DOI:10.1188/03.CJON.151-155 · 0.95 Impact Factor
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ABSTRACT: Preclinical data have demonstrated that ionizing radiation acts synergistically with capecitabine. This report retrospectively assessed the use of capecitabine concurrently with whole-brain radiotherapy (WBRT) in patients with brain metastases from breast cancer. From January 2003 to March 2005, five breast cancer patients with brain metastases were referred for WBRT with concurrent capecitabine. Median age was 44years (range: 38–53). The median dose of capecitabine was 1,000mg/m2 twice daily for 14days (day1–14). Treatment cycles were repeated every 21days, concurrently with WBRT (30Gy, 3Gy per fraction, 5days per week). Median survival after starting WBRT plus capecitabine was 6.5months (range 1–34months). One patient achieved a complete response. Two patients achieved partial response, including one with local control lasting until most recent follow-up. One patient had stable disease. The remaining patient was not assessable for response because of early death. Most commonly reported adverse events were nausea (n=2) and headache (n=2), always grade 1. Other toxicities were grade 3 hand/foot syndrome (n=1), moderate anemia requiring transfusion and dose reduction of capecitabine (n=1), and grade 1 mucositis (n=1). Although promising, these preliminary data warrant further assessment of capecitabine-based chemoradiation in brain metastases from breast cancer and need to be further validated in the setting of a clinical trial.Journal of Neuro-Oncology 07/2009; 93(3):379-384. DOI:10.1007/s11060-008-9791-2 · 2.79 Impact Factor
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ABSTRACT: As therapy for systemic cancers improves, an increasing number of patients are developing brain metastases. Although conventional therapy with surgery, radiation therapy and radiosurgery has improved the outcome of a significant number of patients, many develop multiple lesions that are not amenable to standard treatments. In this review, the current role of chemotherapy and targeted molecular agents for brain metastases is summarized and future directions are discussed.Expert Review of Neurotherapeutics 11/2006; 6(10):1465-79. DOI:10.1586/14737188.8.131.525 · 2.83 Impact Factor