Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Curr Opin Oncol. 2023 Nov 1;35(6):500-506. doi: 10.1097/CCO.0000000000000988. Epub 2023 Aug 29.
Leptomeningeal metastasis is a complication of metastatic breast cancer that has a rising incidence likely due to the increased availability of novel systemic therapies, which have improved survival with better extracranial disease control but with limited intracranial efficacy. A poor prognosis of less than 6 months has historically been associated with leptomeningeal metastasis and it is often an exclusion factor for enrollment in clinical trials. There are limited evidence-based data supporting use of therapeutics in leptomeningeal metastasis patients and recommendations are largely derived from retrospective reports and small prospective studies. However, in recent years, there has been a surge in effective modern therapeutics with promising intracranial activity.
The study aims to review the most recent updates in the management of leptomeningeal metastasis in breast cancer. We discuss the effectiveness and limitations of intrathecal administration, predictive biomarkers in the cerebrospinal fluid, proton radiation therapy and promising new systemic therapies such as antibody drug conjugates.
Ongoing development of clinical trials that allow inclusion of leptomeningeal metastasis are essential for establishing efficacy potential and discovering new treatment options in this population of great unmet need.
脑膜转移是转移性乳腺癌的一种并发症，其发病率不断上升，可能是由于新型全身治疗药物的应用增加，这些药物提高了生存率，使颅外疾病得到更好的控制，但颅内疗效有限。脑膜转移患者的预后较差，中位生存期不足 6 个月，既往常被排除在临床试验之外。目前，脑膜转移患者应用治疗药物的循证医学数据有限，治疗建议主要来自回顾性报告和小型前瞻性研究。然而，近年来，具有颅内活性的有效现代治疗药物大量涌现。
本研究旨在综述乳腺癌脑膜转移治疗的最新进展。我们讨论了鞘内给药的有效性和局限性、脑脊液中的预测性生物标志物、质子放射治疗以及新型有前途的全身治疗药物，如抗体药物偶联物。
开展能够纳入脑膜转移患者的临床试验对于确定这一具有巨大未满足需求的人群的疗效潜力和发现新的治疗选择至关重要。
