Prolonged Survival of Patients With Non-Small-Cell Lung Cancer With Leptomeningeal Carcinomatosis in the Modern Treatment Era

被引：58

作者：

Riess, Jonathan W. ^{[1
,5
,6
]}

Nagpal, Seema ^{[2
]}

Iv, Michael ^{[3
]}

Zeineh, Michael ^{[3
]}

Gubens, Matthew A. ^{[4
]}

Ramchandran, Kavitha ^{[1
]}

Neal, Joel W. ^{[1
]}

Wakelee, Heather A. ^{[1
]}

机构：

[1] Stanford Univ, Sch Med, Dept Med, Div Oncol, Stanford, CA 94305 USA

[2] Stanford Univ, Sch Med, Dept Neurol, Div Neurooncol, Stanford, CA 94305 USA

[3] Stanford Univ, Sch Med, Dept Radiol, Stanford, CA 94305 USA

[4] Univ Calif San Francisco, Dept Med, Div Hematol Oncol, San Francisco, CA USA

[5] Univ Calif Davis, Sch Med, Dept Internal Med, Sacramento, CA 95817 USA

[6] Univ Calif Davis, Ctr Canc, Div Hematol Oncol, Sacramento, CA 95817 USA

来源：

CLINICAL LUNG CANCER | 2014年 / 15卷 / 03期

基金：

美国国家卫生研究院;

关键词：

Chemotherapy; CNS disease; Leptomeningeal carcinomatosis; NSCLC; Targeted therapy; DOSE WEEKLY ERLOTINIB; PHASE-II TRIAL; CHEMOTHERAPY; METASTASES; BEVACIZUMAB; BRAIN; MULTICENTER; CARBOPLATIN; PACLITAXEL; CISPLATIN;

D O I：

10.1016/j.cllc.2013.12.009

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Leptomeningeal carcinomatosis (LM) is a severe complication of non-small-cell lung cancer (NSCLC) historically associated with poor prognosis. New chemotherapeutic agents and targeted treatments could potentially affect the natural history of LM. These data from 30 patients with NSCLC and LM provide evidence for improving survival outcomes in the modern treatment era for this difficult-to-treat complication. Introduction: Leptomeningeal carcinomatosis (LM) is a severe complication of non-small-cell lung cancer (NSCLC) historically associated with poor prognosis. New chemotherapeutic and targeted treatments could potentially affect the natural history of LM. Patients and Methods: Patients with a pathologic diagnosis of NSCLC with LM treated at Stanford between 2003 and 2011 were identified via institutional databases and medical records. LM was defined by cerebrospinal fluid (CSF) that was positive for malignant cells or by LM enhancement on magnetic resonance imaging with gadolinium contrast. Retrospective, landmark analyses were performed to estimate survival. Statistical analyses were performed using SAS Enterprise Guide, version 4.3. Results: LM was identified in 30 patients. All cases were adenocarcinoma; 60% of patients had a known or suspected driver mutation. The mean age was 58 years. Of the 30 patients, 67% were women; 70% were nonsmokers; 27% initially presented with LM; 84% received systemic treatment at or after development of LM; and 53% of these patients received modern systemic therapy for their LM, defined as a regimen containing pemetrexed, bevacizumab, or a tyrosine kinase inhibitor. Mean overall survival after LM diagnosis was 6 months (95% CI, 3-12). Patients who received modern systemic therapy for LM had decreased hazard of death (hazard ratio [HR], 0.24; P = .007). Conclusion: In this retrospective, single-institution analysis, median survival with LM was higher compared with historical experience. Patients who received modern systemic therapy for their LM had particularly good outcomes. These data provide evidence for improving survival outcomes in the modern treatment era for this difficult-to-treat complication.

引用

页码：202 / 206

页数：5

共 21 条

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