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
484P - Treatment (tx) patterns and outcomes in resectable early-stage EGFR-mutated (EGFRm) NSCLC in South Korea: Subgroup analysis of a global real-world (rw) study
Presenter: Myung-Ju Ahn
Session: Poster Display
Resources:
Abstract
485P - LDCT lung cancer screening of never-smokers meta-analysis subgroup analysis: Adenocarcinoma is the highly predictive histology identified in never-smokers
Presenter: Sai-Hong Ou
Session: Poster Display
Resources:
Abstract
486P - Fiscal feasibility and implications of integrating lung cancer screening into Hong Kong’s healthcare system
Presenter: Herbert Ho Fung Loong
Session: Poster Display
Resources:
Abstract
487P - Evaluating the performance of the USPSTF lung cancer screening guidelines in an Asian population of lung cancer patients
Presenter: Jian Wei Tan
Session: Poster Display
Resources:
Abstract
488P - Pulmonary ground glass opacity lesions: Immune ecosystem and its clinical relevances of early-stage lung adenocarcinoma
Presenter: Shensi Shen
Session: Poster Display
Resources:
Abstract
489TiP - BGB-LC-202 (NCT05577702): Phase II Umbrella study of tislelizumab (TIS) monotherapy and TIS-based immunotherapy combinations +/- chemotherapy (CT) as neoadjuvant treatment in Chinese patients (pts) with resectable stage II to IIIA non-small cell lung cancer (NSCLC)
Presenter: Wentao Yu
Session: Poster Display
Resources:
Abstract
491P - Furmonertinib as adjuvant therapy for elderly patients in resected EGFR-mutated non-small cell lung cancer: A double-center, real-world experience
Presenter: Ziheng Wu
Session: Poster Display
Resources:
Abstract
492P - Penpulimab-based combination neoadjuvant/adjuvant therapy for patients with resectable locally advanced non-small cell lung cancer: Preliminary results from a phase II study (ALTER-L043)
Presenter: Changli Wang
Session: Poster Display
Resources:
Abstract
493P - The prognostic value of 4L lymph node dissection in left-sided operable non-small cell lung cancer: A systematic review and meta-analysis
Presenter: Lei Peng
Session: Poster Display
Resources:
Abstract
495P - Intrinsic STING of CD8+T cells regulates self-metabolic reprogramming and exerts anti-tumor effects
Presenter: Qiuli Xu
Session: Poster Display
Resources:
Abstract