Abstract 311P
Background
Carcinomatous meningitis (CM) is a severe complication of breast cancer. BIG conducted a survey to describe the management of CM.
Methods
A questionnaire was created by the BMTF and distributed to all BIG groups, requesting one answer per site.
Results
245 sites responded from 55 groups, 121 in Europe, 9 in North America, 40 in Central and South America, 59 in Asia and 16 in Australia, 44% were university hospitals, 24% general hospitals with oncology units, 23% oncology centers and 9% private hospitals. The majority of sites (56%) report seeing <5 CM cases annually, more in oncology centers and teaching hospitals vs general and private hospitals [PC1] [SC2] (49% vs 34% p=0,0291). 60% report no increase in the number of cases of LM. 63% of sites actively investigate for CM in the presence of either symptoms or radiological evidence while 33% only in the presence of symptoms. A diagnosis of CM is based on CSF cytology and MRI findings in 71% of sites, while in 24% MRI findings alone suffice. 97% of sites treat CM, while 52% also refer all patients to palliative care. Treatment decisions are based upon systemic tumor burden, symptoms, CNS parenchymal disease, Performance Status, prognosis, and patient preference. Subtype of breast cancer influences management in only 64%. Intrathecal therapy is used in 42% of sites (Europe 50%, Latin America 48%, Australia 31%, Asia 29%, North America 22%), methotrexate being the drug of choice in 75%, infused through an Ommaya catheter and/or a lumbar puncture. 19% of sites use Ommaya catheters exclusively, while CSF flow is rarely checked. Radiotherapy is used for various indications in 88% of the centers. CSF cytology is not repeated after therapy in 47% of sites and follow up MRIs are used in 56%. 92% of sites do not have a national registry for patients with CNS metastases and of those that do, very few (25%) have one for CM. Most sites are interested in participating both in a registry as well as in clinical studies for CM with 62% favouring subtype specific studies.
Conclusions
This is the first study to map out the management of CM globally, showing a high degree of homogeneity in the clinical approach to this condition. There is significant interest in setting up a registry and conducting research.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Breast International Group (BIG).
Funding
Has not received any funding.
Disclosure
E. Razis: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Funding: Novartis; Financial Interests, Personal, Funding: Parexel; Financial Interests, Personal, Funding: Tesaro; Non-Financial Interests, Other, Honoraria: Bristol Myers Squibb; Other, Travel, Accommodations, Expenses: Genesis Pharmaceuticals; Other, Travel, Accommodations, Expenses: LEO Pharma; Other, Travel, Accommodations, Expenses: Roche; Other, Travel, Accommodations, Expenses: Genekor; Other, Travel, Accommodations, Expenses: Merck; Other, Travel, Accommodations, Expenses: Ipsen; Other, Travel, Accommodations, Expenses: Sanofi. R. Bartsch: Financial Interests, Advisory Role: Astra-Zeneca; Financial Interests, Advisory Role: Daiichi Sankyo; Financial Interests, Advisory Role: Eisai; Financial Interests, Advisory Role: Eli Lilly; Financial Interests, Advisory Role: MSD; Financial Interests, Advisory Role: Novartis; Financial Interests, Advisory Role: Pfizer; Financial Interests, Advisory Role: Pierre-Fabre; Financial Interests, Advisory Role: Puma; Financial Interests, Advisory Role: Roche; Financial Interests, Advisory Role: Seagen; Financial Interests, Other, Lecture Honoraria: AstraZeneca; Financial Interests, Other, Lecture Honoraria: Celgene; Financial Interests, Other, Lecture Honoraria: Eli Lilly; Financial Interests, Other, Lecture Honoraria: Novartis; Financial Interests, Other, Lecture Honoraria: Pfizer; Financial Interests, Other, Lecture Honoraria: Pierre-Fabre; Financial Interests, Other, Lecture Honoraria: Roche; Financial Interests, Other, Lecture Honoraria: Seagen; Financial Interests, Other, Research Support: Daiichi Sankyo; Financial Interests, Other, Research Support: MSD; Financial Interests, Other, Research Support: Novartis; Financial Interests, Other, Research Support: Roche. B. Linderholm: Financial Interests, Advisory Board: AstraZeneca; Financial Interests, Advisory Board: Pfizer; Financial Interests, Advisory Board: Merck; Financial Interests, Advisory Board: Eli Lilly; Financial Interests, Advisory Board: Pierre Fabre; Financial Interests, Advisory Board: Daiichi Sankyo/UCB Japan. D. Fumagali: Financial Interests, Funding: AstraZeneca; Financial Interests, Funding: Biovica; Financial Interests, Funding: GlaxoSmithKline; Financial Interests, Funding: Novartis; Financial Interests, Funding: Pfizer; Financial Interests, Funding: Roche/Genentech; Financial Interests, Funding: Tesaro; Financial Interests, Funding: Sanofi; Financial Interests, Funding: Servier. G. Rossi: Financial Interests, Funding: AstraZeneca; Financial Interests, Funding: Roche/Genentech; Financial Interests, Funding: Sanofi. V. Müller: Financial Interests, Other, grants and personal personal fees: Amgen; Financial Interests, Other, grants and personal personal fees: AstraZeneca; Financial Interests, Other, grants and personal personal fees: Daiichi Sankyo; Financial Interests, Other, grants and personal personal fees: Eisai; Financial Interests, Other, grants and personal personal fees: Pfizer; Financial Interests, Other, grants and personal personal fees: MSD; Financial Interests, Other, grants and personal personal fees: Novartis; Financial Interests, Other, grants and personal personal fees: Roche; Financial Interests, Other, grants and personal personal fees: Teva; Financial Interests, Other, grants and personal personal fees: Seattle Genetics; Financial Interests, Other, consultancy honoraria: Genomic Health; Financial Interests, Other, consultancy honoraria: Hexal; Financial Interests, Other, consultancy honoraria: Roche; Financial Interests, Other, consultancy honoraria: Pierre Fabre; Financial Interests, Other, consultancy honoraria: Amgen; Financial Interests, Other, consultancy honoraria: ClinSol; Financial Interests, Other, consultancy honoraria: Novartis; Financial Interests, Other, consultancy honoraria: MSD; Financial Interests, Other, consultancy honoraria: Daiichi Sankyo; Financial Interests, Other, consultancy honoraria: Eisai; Financial Interests, Other, consultancy honoraria: Lilly; Financial Interests, Other, consultancy honoraria: Tesaro; Financial Interests, Other, consultancy honoraria: Nektar; Financial Interests, Other, personal fees: Genomic Health; Financial Interests, Other, personal fees: Hexal; Financial Interests, Other, personal fees: Roche; Financial Interests, Other, personal fees: Pierre Fabre; Financial Interests, Other, personal fees: Amgen; Financial Interests, Other, personal fees: ClinSol; Financial Interests, Other, personal fees: Novartis; Financial Interests, Other, personal fees: MSD; Financial Interests, Other, personal fees: Daiichi Sankyo; Financial Interests, Other, personal fees: Eisai; Financial Interests, Other, personal fees: Lilly; Financial Interests, Other, personal fees: Tesaro; Financial Interests, Other, personal fees: Nektar. C. Palmieri: Financial Interests, Other, Honoraria: Pfizer; Financial Interests, Other, Honoraria: Roche; Financial Interests, Other, Honoraria: Eli Lilly; Financial Interests, Other, Honoraria: Novartis; Financial Interests, Other, Advisory board honoraria: Pfizer; Financial Interests, Other, Advisory board honoraria: Roche; Financial Interests, Other, Advisory board honoraria: Novartis; Financial Interests, Other, Advisory board honoraria: Eli Lilly; Financial Interests, Other, Advisory board honoraria: AstraZeneca; Financial Interests, Other, Conference sponsorship: Roche; Financial Interests, Other, Conference sponsorship: Daiichi Sankyo. I. Witzel: Financial Interests, Other, Speaker‘s Honoraria: Amgen; Financial Interests, Other, speaker‘s honoraria: MSD; Financial Interests, Other, speaker‘s honoraria: Novartis; Financial Interests, Other, speaker‘s honoraria: Pierre Fabre Pharme; Financial Interests, Other, speaker‘s honoraria: Pfizer; Financial Interests, Other, speaker‘s honoraria: Roche; Financial Interests, Other, speaker‘s honoraria: Sanofi-Aventis. All other authors have declared no conflicts of interest.