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
471TiP - A group sequential, response-adaptive randomized double-blinded clinical trial to evaluate add-on olanzapine plus pregabalin to prevent chemotherapy-induced nausea and vomiting (CINV ) in patients belonging to low socio-economic status
Presenter: Mathan Ramasubbu
Session: Poster Display
Resources:
Abstract
472P - Risk of recurrence and optimal adjuvant treatment in invasive lung adenocarcinomas manifesting as radiological part-solid nodules
Presenter: Yang Wo
Session: Poster Display
Resources:
Abstract
473P - Treatment (tx) patterns in resectable stage IA–IIIA non-small cell lung cancer (NSCLC) in China: Subgroup analysis of a global real-world (rw) study
Presenter: Chih-Chi Yang
Session: Poster Display
Resources:
Abstract
474P - The efficacy of image guided coil localisation for surgical resection of undiagnosed solitary lung nodule
Presenter: Jun Rey Leong
Session: Poster Display
Resources:
Abstract
475P - 5-year overall survival and disease free survival outcome between lobectomy and segmentectomy for early stage lung cancer in a mixed Asian population
Presenter: Jianye Chen
Session: Poster Display
Resources:
Abstract
478P - Peri-operative risks in curative lung resection of early stage primary lung cancer patients above 70 years old in a mixed Asian population
Presenter: Ian Goh
Session: Poster Display
Resources:
Abstract
480P - Aumolertinib as adjuvant therapy for resectable stage I-III EGFR-mutant NSCLC: Also effective in EGFR co-mutation
Presenter: Lin Wu
Session: Poster Display
Resources:
Abstract
481P - Comparative analysis of three NGS platforms assessing tumor mutational burden and mutational landscape in resectable non-small cell lung cancer
Presenter: Jii Bum Lee
Session: Poster Display
Resources:
Abstract
482P - Prevalence of EGFR mutations (EGFRm) and its subtypes in patients (pts) with resected stage I-III NSCLC: Results from EARLY-EGFR Singapore cohort
Presenter: Puey Ling Chia
Session: Poster Display
Resources:
Abstract
483P - Genetic profiles and evolutionary trajectory of early stage lung adenocarcinoma (AAH, AIS, MIA and IAC) revealed by multiplex sequecing
Presenter: lixuan lin
Session: Poster Display
Resources:
Abstract