Update on the management of leptomeningeal disease in solid organ malignancy: Systemic, intrathecal and novel therapies.
Sanlin Fisher, Monique Topp, Angus Airth et al.
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In 30 seconds
This systematic review evaluated ten prospective trials involving 520 patients with leptomeningeal disease (LMD) from solid tumors, focusing on systemic, intrathecal, and novel therapies. Notably, osimertinib showed a median overall survival of 13-15 months in EGFR-mutant NSCLC-LMD, with an intracranial objective response rate of 51.6%.
Key findings
- Osimertinib in EGFR-mutant NSCLC-LMD resulted in a median overall survival of 13-15 months.
- Intrathecal pemetrexed demonstrated an overall response rate of 43.5-80.3% and median overall survival of 9-12 months.
- Intrathecal liposomal cytarabine improved progression-free survival from 2.2 to 3.8 months.
- Quality of life improvements were noted in the BLOSSOM study, though overall reporting was minimal.
Why it matters
Leptomeningeal disease represents a significant challenge in oncology, often leading to poor outcomes. Understanding the efficacy of emerging therapies can guide treatment decisions and improve patient management in this complex condition.
What to keep in mind
The review highlights reliance on single-arm designs, heterogeneous endpoints, and sparse quality of life data, which may limit the robustness of the findings.