Abstract 527P
Background
Leptomeningeal metastases (LM) of lung cancer represent a severe neurological complication with a poor prognosis and limited effective treatments. Although intraventricular chemotherapy (IVC) is the preferred management for LM, there is currently insufficient data to support its effectiveness.
Methods
We conducted a retrospective study that analyzed data from consecutive patients with LM from lung adenocarcinoma who underwent Ommaya reservoir insertion at the Nanjing Chest Hospital between 2020 and 2022. The diagnosis of LM was based on either cerebrospinal fluid (CSF) cytology or concordant clinical and neuroimaging findings. The chemotherapy regimen consisted of pemetrexed (30mg or 50mg) and dexamethasone (5mg) administered twice a week for up to 2 weeks during the induction phase, followed by a maintenance phase once a month until progression or maximal doses were reached.
Results
We retrospectively analyzed 56 patients (median age, 56 years) with driver gene mutations, including 46 patients with EGFR mutations, 2 patients with other gene mutations, and 8 patients with non-driver genes. Of the patients, 48.3% had an ECOG PS of 4, 35.7% had an ECOG PS of 3, and 16% had an ECOG PS of 2. Additionally, 41 patients (73.2%) received a 30mg dose of pemetrexed, and 15 patients (26.8%) received a 50mg dose. In all patients, 31 had a response, 19 had stable disease (SD), and 6 had disease progression (PD), resulting in an overall response rate (ORR) of 55.4% and a disease control rate (DCR) of 89.3%. The median progression-free survival (mPFS) was 6.8 months, and the median overall survival (mOS) was not reached. Subgroup analysis showed that the mPFS for the pemetrexed 50mg and 30mg groups was 12 months and 6.8 months, respectively (p=0.006), and the mPFS was 9.6 months versus 4 months in the ECOG PS of 2-3 and 4 arms(Fig1B), respectively (p=0.001). The overall adverse event (AE) rate was 65%, with all adverse effects, including nausea, vomiting, seizures, and myelosuppression, being mild and transient.
Conclusions
In this real-world study, IVC with pemetrexed demonstrated excellent and encouraging results in patients with lung adenocarcinoma and LM, at an acceptable cost of toxicity.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
173P - Lenvatinib (L) versus sorafenib (S) second-line therapy in hepatocellular carcinoma (HCC) patients progressed to atezolizumab plus bevacizumab (AB)
Presenter: Mara Persano
Session: Poster Display
Resources:
Abstract
174P - Unlocking the potential of blood-based biomarkers in pancreatic cancer for early detection and therapeutic screening
Presenter: Belinda Lee
Session: Poster Display
Resources:
Abstract
175P - Genomic evolution of peritoneal metastasis in gastric adenocarcinoma
Presenter: Lan Tu
Session: Poster Display
Resources:
Abstract
176P - Identification of novel diagnostic markers for pancreatic neuroendocrine tumors by proteomics with patient blood
Presenter: HEE SEON Kim
Session: Poster Display
Resources:
Abstract
177P - Burden of stomach cancer attributable to smoking in South Asia from 1990-2019, its projection of deaths to 2040: A benchmarking and comparative analysis
Presenter: Pranay Vaghela
Session: Poster Display
Resources:
Abstract
178P - Survival benefit of splenic hilar lymph nodes (no.10) dissection in B4 type gastric carcinoma: An IPTW propensity score analysis of large multi-institutional data
Presenter: Oh Jeong
Session: Poster Display
Resources:
Abstract
179P - The impact of pre-operative nutritional/rehabilitative assessments and support on postoperative outcomes in very elderly gastric cancer patients
Presenter: Yuki Ushimaru
Session: Poster Display
Resources:
Abstract
180P - Appraisal of surgical outcomes and oncological efficiency of intraoperative adverse events in robotic radical gastrectomy for gastric cancer
Presenter: shangguan Zhixin
Session: Poster Display
Resources:
Abstract
181P - TQB2450 (PD-L1 blockade) in combination with anlotinib as a perioperative treatment for patients with hepatocellular carcinoma at high risk of recurrence: Primary results from a prospective, single-arm, phase Ib study
Presenter: Zhen Huang
Session: Poster Display
Resources:
Abstract
182P - Cytoreductive surgery and chemotherapy in metastatic gastric adenocarcinoma: A population-based study
Presenter: Dana Al Zamer
Session: Poster Display
Resources:
Abstract