Approximately 5% of patients with cancer develop leptomeningeal metastases (LM). As increasing numbers of patients with cancer survive longer and our diagnostic imaging improves, LM is being diagnosed more frequently and estimated at 30,000 US cases annually, with a median survival of 4-6 weeks without treatment. Current treatment involves radiation to symptomatic sites of the neuraxis and to sites of bulk disease seen on imaging. Intrathecal (IT) chemotherapy is designed to treat tumor cells in the CSF, preventing the development of new symptomatic sites of disease. Systemically administered chemotherapy has limited access to the CSF due to the blood–brain barrier (BBB). IT agents, such as methotrexate, thiotepa, cytarabine or topotecan, are typically infused through a ventricular reservoir and depend on passive diffusion for distribution. Neurpheresis poses a novel approach to rapidly clear the CSF of tumor cells and circulate tailored chemotherapeutic agents to enhance systemic treatment in an effort to reduce the high mortality of LM and extend survival.
Collaborating and Supporting Researchers