Leptomeningeal metastasis from de novo metastatic nasopharyngeal carcinoma: a case report

BACKGROUND: Leptomeningeal metastasis (LM) have a poor prognosis and rare studies have reported LM from nasopharyngeal carcinoma (NPC). Immune checkpoint inhibitor (ICI) was the standard first line treatment for metastatic NPC and was reported to improve intracranial response and survival in several types of cancer. CASE DESCRIPTION: In this case presentation, we present a case of a 26-year-old man with de novo metastatic NPC who initially complained of left cervical masses. A PET/CT and MRI scan revealed multiple liver, bone and brain metastasis. The patient received initial anti PD-1 antibody camrelizumab combined with chemotherapy, followed by radiotherapy to local and regional lesions. Two weeks after that, the patient experienced transient unconsciousness, persistent fatigue and pain in both lower limbs. Then MRI revealed leptomeningeal linear enhancement, hydrocephalus and increased multiple intracranial metastatic lesions. So the patient was diagnosed of LM. The therapeutic regimen then consisted of whole brain radiotherapy combined with oral capecitabine. A partial response was demonstrated and the progression-free survival (PFS) was 5 months since the diagnosis of LM. To our knowledge, this is the first case of LM from NPC treatment with ICI. CONCLUSIONS: This case highlights the diagnosis and treatment of LM from NPC, and provides an optional regimen after ICI failure.