Breast Cancer Research and Treatment

, Volume 131, Issue 1, pp 343–346 | Cite as

Resolution of extensive leptomeningeal metastasis and clinical spinal cord compression from breast cancer using weekly docetaxel chemotherapy

  • Bethany Wilson
  • Christy Sapp
  • Ghadeer Abdeen
  • Atheel Kamona
  • Suleiman Massarweh
Brief Report

Abstract

Metastatic breast cancer to the leptomeninges is a late event in the disease course and is associated with significant morbidity and a grave prognosis. Treatment typically involves direct intrathecal injection of chemotherapy into the cerebrospinal fluid compartment since systemic chemotherapy penetrates poorly to the central nervous system. Here we report an interesting clinical observation involving a patient presenting with leptomeningeal spread of breast cancer causing extensive spinal cord compression with obliteration of the subarachnoid space, thus precluding the use of direct intrathecal chemotherapy. We administered systemic chemotherapy using weekly docetaxel with complete radiographic resolution of her disease and recovery from clinical spinal cord compression. While this is a single clinical observation, weekly administration of docetaxel in this circumstance may have been associated with improved drug “escape” into the central nervous system and better antitumor effect. Because leptomeningeal disease is typically a late event in metastatic breast cancer, resistance to therapeutic intervention may reflect intrinsically resistant disease in the setting of extensive prior therapy rather than a routine problem with systemic drug delivery to the CNS. Studying patterns of disease relapse in patients who had received adjuvant weekly taxanes may provide insights into this hypothesis.

Keywords

Breast cancer Leptomeningeal carcinomatosis Chemotherapy Docetaxel 

Notes

Disclosures

There are no relevant disclosures to report.

References

  1. 1.
    Chamberlain MC (2005) Neoplastic meningitis. J Clin Oncol 23:3605–3613. doi: 10.1200/jco.2005.01.131 PubMedCrossRefGoogle Scholar
  2. 2.
    Boogerd W, Dorresteijn LD, van Der Sande JJ, de Gast GC, Bruning PF (2000) Response of leptomeningeal metastases from breast cancer to hormonal therapy. Neurology 55:117–119PubMedGoogle Scholar
  3. 3.
    Chamberlain MC (2001) Response of leptomeningeal metastases from breast cancer to hormonal therapy. Neurology 56:425–426PubMedGoogle Scholar
  4. 4.
    Ozdogan M, Samur M, Bozcuk HS, Sagtas E, Yildiz M, Artac M, Savas B (2003) Durable remission of leptomeningeal metastasis of breast cancer with letrozole: a case report and implications of biomarkers on treatment selection. Jpn J Clin Oncol 33:229–231. doi: 10.1093/jjco/hyg046 PubMedCrossRefGoogle Scholar
  5. 5.
    Sanna G, Franceschelli L, Rotmensz N, Botteri E, Adamoli L, Marenghi C, Munzone E, Cossu Rocca M, Verri E, Minchella I, Medici M, Catania C, Magni E, Goldhirsch A, Nole F (2007) Brain metastases in patients with advanced breast cancer. Anticancer Res 27:2865–2869PubMedGoogle Scholar
  6. 6.
    Crivellari D, Pagani O, Veronesi A, Lombardi D, Nole F, Thrlimann B, Hess D, Borner M, Bauer J, Martinelli G, Graffeo R, Sessa C, Goldhirsch A, International Breast Cancer Study G (2001) High incidence of central nervous system involvement in patients with metastatic or locally advanced breast cancer treated with epirubicin and docetaxel. Ann Oncol 12:353–356PubMedCrossRefGoogle Scholar
  7. 7.
    Freilich RJ, Seidman AD, DeAngelis LM (1995) Central nervous system progression of metastatic breast cancer in patients treated with paclitaxel. Cancer 76:232–236PubMedCrossRefGoogle Scholar
  8. 8.
    Kosmas C, Malamos NA, Tsavaris NB, Stamataki M, Gregoriou A, Rokana S, Vartholomeou M, Antonopoulos MJ (2002) Isolated leptomeningeal carcinomatosis (carcinomatous meningitis) after taxane-induced major remission in patients with advanced breast cancer. Oncology 63:6–15PubMedCrossRefGoogle Scholar
  9. 9.
    Kosmas C, Malamos NA, Tsavaris NB, Stamataki M, Stefanou S, Gregoriou A, Rokana S, Vartholomeou M, Antonopoulos MJ (2002) Leptomeningeal carcinomatosis after major remission to taxane-based front-line therapy in patients with advanced breast cancer. J Neurooncol 56:265–273PubMedCrossRefGoogle Scholar
  10. 10.
    Tham YL, Hinckley L, Teh BS, Elledge R (2006) Long-term clinical response in leptomeningeal metastases from breast cancer treated with capecitabine monotherapy: a case report. Clin Breast Cancer 7:164–166PubMedCrossRefGoogle Scholar
  11. 11.
    Ekenel M, Hormigo AM, Peak S, Deangelis LM, Abrey LE (2007) Capecitabine therapy of central nervous system metastases from breast cancer. J Neurooncol 85:223–227PubMedCrossRefGoogle Scholar
  12. 12.
    Herrington JD, Di Nunno L, Rinehart JJ (1998) Lack of CNS penetration of docetaxel in a patient with leptomeningeal carcinomatosis. Ann Pharmacother 32:611–612. doi: 10.1345/aph.17359 PubMedCrossRefGoogle Scholar
  13. 13.
    Ten Tije AJ, Loos WJ, Zhao M, Baker SD, Enting RH, van der Meulen H, Verweij J, Sparreboom A (2004) Limited cerebrospinal fluid penetration of docetaxel. Anticancer Drugs 15:715–718PubMedCrossRefGoogle Scholar
  14. 14.
    Sparano JA, Wang M, Martino S, Jones V, Perez EA, Saphner T, Wolff AC, Sledge GW Jr, Wood WC, Davidson NE (2008) Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 358:1663–1671. doi: 10.1056/NEJMoa0707056 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Bethany Wilson
    • 1
  • Christy Sapp
    • 1
  • Ghadeer Abdeen
    • 2
  • Atheel Kamona
    • 2
  • Suleiman Massarweh
    • 1
  1. 1.Department of Internal MedicineUniversity of Kentucky and Markey Cancer CenterLexingtonUSA
  2. 2.King Hussein Cancer CenterAmmanJordan

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