Abstract 322P
Background
Therapeutic advances have improved systemic control and overall survival (OS) in advanced breast cancer (aBC) especially in RH + / HER2- and HER2 +). Patients with leptomeningeal metastasis (LM), with an increasing frequency (5 to 20% of aBC), have limited therapeutic options in a drug sanctuary, and present short outcomes: 4–6 weeks when untreated.One of the therapeutic option consist on intrathecal (IT) CSF chemotherapy (mainly methotrexate, thiotepa, cytarabine +/- hydrocortisone). Intrathecal catheter connected to a subcutaneous port is a recent option that arose during the last decade for intrathecal chemotherapy and represent a less invasive option, easier to manage than an intraventricular device. The current study was conducted to evaluate the efficacy and safety of intra-cerebro spinal fluid (CSF) chemotherapy in aBC.
Methods
We retrieved retrospectively data from patients treated for an aBC with LM, using intrathecal device for intrathecal chemotherapy between January 2013 and May 2020 at ICO. Primary endpoint was overall survival.
Results
Thirty patients were implanted and received intrathecal Chemotherapy. All Patients harbored HER2 negative aBC included 7 patients with triple-negative BC. The median follow-up was 76.5 months (95% confidence interval (CI): 11.6-NA). All patients received Intra CSF methotrexate (15 mg) and/or received thiotepa (60%), associated with hydrocortisone. The median number of courses per patient was 8 (range: 2 to 27). The median overall survival was 158 days (95%CI: 87-235). Only three complications were worth to be reported (One dislodgment, one infection and one hematoma). Repetitive chemotherapy infusions were accurate and easy to give but also painless and well tolerated by the patient.
Conclusions
Intrathecal chemotherapy through a catheter implanted is an efficient option to manage IT chemotherapy for aBC and is suitable for long-term use with a good tolerance profile of repeated injections. The OS data are consistent with recent studies. Patient reported outcomes (PRO) in evaluation of IT chemotherapy toxicity are being developed.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
P. Augereau: Financial Interests, Other, Consulting public presentation: AstraZeneca; Financial Interests, Other, Consulting public presentation: Novartis; Financial Interests, Other, Consulting public presentation: Pfizer; Financial Interests, Other, Consulting public presentation: Lilly. D. Dupoiron: Financial Interests, Other, consultant: Medtronic. All other authors have declared no conflicts of interest.