Cargando…

23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES

BACKGROUND: Nearly 5–8% of solid cancers present with leptomeningeal disease (LMD). Patients with LMD have a dismal prognosis with survival measured in weeks-to-months. The pathophysiology of this devastating disease remains unknown. METHODS: A retrospective chart review was performed of twenty-five...

Descripción completa

Detalles Bibliográficos
Autores principales: Pina, Yolanda, Evernden, Brittany, Smalley, Keiran, Forsyth, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401376/
http://dx.doi.org/10.1093/noajnl/vdaa073.013
_version_ 1783566550944448512
author Pina, Yolanda
Evernden, Brittany
Smalley, Keiran
Forsyth, Peter
author_facet Pina, Yolanda
Evernden, Brittany
Smalley, Keiran
Forsyth, Peter
author_sort Pina, Yolanda
collection PubMed
description BACKGROUND: Nearly 5–8% of solid cancers present with leptomeningeal disease (LMD). Patients with LMD have a dismal prognosis with survival measured in weeks-to-months. The pathophysiology of this devastating disease remains unknown. METHODS: A retrospective chart review was performed of twenty-five adult patients with LMD due to melanoma who were enrolled in the MCC 50172 clinical trial between 05/26/2015 and 07/17/2018. RESULTS: Patients had a median age 63 years (31–80) at diagnosis with LMD. Sixteen had confirmed LMD and five did not meet criteria for LMD, but had positive cerebrospinal fluid (CSF)-circulating tumor cells (CTC’s). Those with LMD had a median KPS of 70 (30–90) at presentation, and symptoms most commonly included altered mentation n=6 (37%), headaches n=4 (25%), focal weakness n=3 (19%), and paresthesia n=2 (12%). Eleven patients were diagnosed by MRI. Ten patients (62%) had positive CSF cytology on first attempt and fourteen (87%) on first-two attempts. Lumbar puncture mean OP was 29.4 cmH2O (18–65), with CSF WBC 21.8/cumm (SD 25.6), RBC 2942.5/cumm (SD 9056.1), and protein 187.6 mg/dL (SD 166.1). CSF-CTC’s CellSearch analysis had a sensitivity of 0.75 (12[12 + 4]) and specificity of 0.44 (4[4 + 5]); PPV 0.71 and NPV 0.50. Twelve patients with LMD had positive CSF-CTC’s. Prior to LMD diagnosis, patients were treated with immune checkpoint inhibitors (ICI’s) n=9 (56%), BRAF+/-MEK inhibitors n=5 (31%), and/or RT n=5 (31%). Patients with LMD were treated with Ommaya n=13 +VPS n=3, WBRT n=7, ICI’s n=5, BRAF+MEK inhibitors n=4, and IT topotecan. LMD patients had a median survival 3.27 months after diagnosis (0.30–39). Two patients outlived their counterparts by 21.1 and 39.0 months. The 2 long-term survivors were treated with WBRT and either ICI, pembrolizumab or ipilimumab+nivolumab. CONCLUSION: Clinical studies in LMD can provide critical insights and help to develop improved guidelines and current therapies.
format Online
Article
Text
id pubmed-7401376
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-74013762020-08-06 23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES Pina, Yolanda Evernden, Brittany Smalley, Keiran Forsyth, Peter Neurooncol Adv Supplement Abstracts BACKGROUND: Nearly 5–8% of solid cancers present with leptomeningeal disease (LMD). Patients with LMD have a dismal prognosis with survival measured in weeks-to-months. The pathophysiology of this devastating disease remains unknown. METHODS: A retrospective chart review was performed of twenty-five adult patients with LMD due to melanoma who were enrolled in the MCC 50172 clinical trial between 05/26/2015 and 07/17/2018. RESULTS: Patients had a median age 63 years (31–80) at diagnosis with LMD. Sixteen had confirmed LMD and five did not meet criteria for LMD, but had positive cerebrospinal fluid (CSF)-circulating tumor cells (CTC’s). Those with LMD had a median KPS of 70 (30–90) at presentation, and symptoms most commonly included altered mentation n=6 (37%), headaches n=4 (25%), focal weakness n=3 (19%), and paresthesia n=2 (12%). Eleven patients were diagnosed by MRI. Ten patients (62%) had positive CSF cytology on first attempt and fourteen (87%) on first-two attempts. Lumbar puncture mean OP was 29.4 cmH2O (18–65), with CSF WBC 21.8/cumm (SD 25.6), RBC 2942.5/cumm (SD 9056.1), and protein 187.6 mg/dL (SD 166.1). CSF-CTC’s CellSearch analysis had a sensitivity of 0.75 (12[12 + 4]) and specificity of 0.44 (4[4 + 5]); PPV 0.71 and NPV 0.50. Twelve patients with LMD had positive CSF-CTC’s. Prior to LMD diagnosis, patients were treated with immune checkpoint inhibitors (ICI’s) n=9 (56%), BRAF+/-MEK inhibitors n=5 (31%), and/or RT n=5 (31%). Patients with LMD were treated with Ommaya n=13 +VPS n=3, WBRT n=7, ICI’s n=5, BRAF+MEK inhibitors n=4, and IT topotecan. LMD patients had a median survival 3.27 months after diagnosis (0.30–39). Two patients outlived their counterparts by 21.1 and 39.0 months. The 2 long-term survivors were treated with WBRT and either ICI, pembrolizumab or ipilimumab+nivolumab. CONCLUSION: Clinical studies in LMD can provide critical insights and help to develop improved guidelines and current therapies. Oxford University Press 2020-08-04 /pmc/articles/PMC7401376/ http://dx.doi.org/10.1093/noajnl/vdaa073.013 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Supplement Abstracts
Pina, Yolanda
Evernden, Brittany
Smalley, Keiran
Forsyth, Peter
23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES
title 23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES
title_full 23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES
title_fullStr 23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES
title_full_unstemmed 23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES
title_short 23. RETROSPECTIVE REVIEW OF ADULT PATIENTS WITH LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA AT MOFFITT CANCER CENTER: DIAGNOSIS, TREATMENT AND OUTCOMES
title_sort 23. retrospective review of adult patients with leptomeningeal disease secondary to melanoma at moffitt cancer center: diagnosis, treatment and outcomes
topic Supplement Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401376/
http://dx.doi.org/10.1093/noajnl/vdaa073.013
work_keys_str_mv AT pinayolanda 23retrospectivereviewofadultpatientswithleptomeningealdiseasesecondarytomelanomaatmoffittcancercenterdiagnosistreatmentandoutcomes
AT everndenbrittany 23retrospectivereviewofadultpatientswithleptomeningealdiseasesecondarytomelanomaatmoffittcancercenterdiagnosistreatmentandoutcomes
AT smalleykeiran 23retrospectivereviewofadultpatientswithleptomeningealdiseasesecondarytomelanomaatmoffittcancercenterdiagnosistreatmentandoutcomes
AT forsythpeter 23retrospectivereviewofadultpatientswithleptomeningealdiseasesecondarytomelanomaatmoffittcancercenterdiagnosistreatmentandoutcomes