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Advancements in the Treatment of Cerebrovascular Complications of Cancer

  • Cerebrovascular Disorders (Dara G. Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

To present the new guidelines and therapeutic options regarding cerebrovascular complications of cancer, mainly ischemic stroke, cerebral venous thrombosis (CVT), and leptomeningeal carcinomatosis (LMC).

Recent findings

A temporal trend study (2019) revealed that clinicians are still reluctant to apply thrombolysis to cancer patients, although two new studies (2018) reported no increased mortality. Several clinical trials on direct oral anticoagulants (DOACs) showed their superiority or, at least, non-inferiority compared with low molecular weight heparins in the treatment of venous thromboembolism (VTE) (2018–2019). These trials helped in formulating the new guidelines that are being published and the decisions made for cancer-associated thrombosis (CAT) as a whole. A new DOAC antidote was also officially released (US 2018, Europe 2019).

Summary

Thrombolysis is safe in a malignancy setting, thus cancer per se should not be considered a contraindication for thrombolysis. Clinical trials assessing the newest DOACs for cancer-associated arterial thrombosis are scarce; however, based on data from VTE studies, the newest DOACs seem to be safe for CAT in patients that are not in high risk of bleeding or suffering from certain malignancies. The treatment should not be ceased after 6 months, but rather continued as long as the cancer remains active. Decompressive craniectomy should maintain its place in patients with CVST in risk of herniation. Last, the future also holds much promise on the role of novel compounds to be used in LMC.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Dardiotis E, Aloizou AM, Markoula S, Siokas V, Tsarouhas K, Tzanakakis G, et al. Cancer-associated stroke: pathophysiology, detection and management (review). Int J Oncol. 2019;54(3):779–96. https://doi.org/10.3892/ijo.2019.4669.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Tsatsakis A, Docea AO, Calina D, Tsarouhas K, Zamfira LM, Mitrut R, et al. A Mechanistic and pathophysiological approach for stroke associated with drugs of abuse. J Clin Med. 2019;8(9). https://doi.org/10.3390/jcm8091295.

  3. Navi BB, Iadecola C. Ischemic stroke in cancer patients: a review of an underappreciated pathology. Ann Neurol. 2018;83(5):873–83. https://doi.org/10.1002/ana.25227.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Riess H, Prandoni P, Harder S, Kreher S, Bauersachs R. Direct oral anticoagulants for the treatment of venous thromboembolism in cancer patients: potential for drug-drug interactions. Crit Rev Oncol Hematol. 2018;132:169–79. https://doi.org/10.1016/j.critrevonc.2018.09.015.

    Article  PubMed  Google Scholar 

  5. Murthy SB, Karanth S, Shah S, Shastri A, Rao CP, Bershad EM, et al. Thrombolysis for acute ischemic stroke in patients with cancer: a population study. Stroke. 2013;44(12):3573–6. https://doi.org/10.1161/strokeaha.113.003058.

    Article  CAS  PubMed  Google Scholar 

  6. • Chatterjee A, Merkler AE, Murthy SB, Burch JE, Chen ML, Gialdini G, et al. Temporal trends in the use of acute recanalization therapies for ischemic stroke in patients with cancer. J Stroke Cerebrovasc Dis. 2019;28(8):2255–61. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.05.009. A temporal trends study that revealed that both the rates of IV thrombolysis and EV treatment for stroke therapy increased considerably from 1998 to 2015 in cancer and non-cancer patients. The EV treatment was administered at similar rates in both time points in the two groups, but IV thrombolysis was administered less often in cancer patients in 2015; 4.91% of cancer patients with IS received IV thrombolysis, compared to 7.22% of non-cancer patients.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sanossian N, Djabiras C, Mack WJ, Ovbiagele B. Trends in cancer diagnoses among inpatients hospitalized with stroke. J Stroke Cerebrovasc Dis. 2013;22(7):1146–50. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.11.016.

    Article  PubMed  Google Scholar 

  8. Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Elkind MSV, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol. 2017;70(8):926–38. https://doi.org/10.1016/j.jacc.2017.06.047.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Masrur S, Abdullah AR, Smith EE, Hidalgo R, El-Ghandour A, Rordorf G, et al. Risk of thrombolytic therapy for acute ischemic stroke in patients with current malignancy. J Stroke Cerebrovasc Dis. 2011;20(2):124–30. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.10.010.

    Article  PubMed  Google Scholar 

  10. Geraldes T, Pereira L, Guarda C, Grunho M, Ribeiro AC, Coimbra J, et al. Safety and outcome of rtPA in acute ischemic stroke in patients with active cancer: case-control study. Rev Neurol. 2017;65(1):13–8.

    CAS  PubMed  Google Scholar 

  11. Weeda ER, Bohm N. Association between comorbid cancer and outcomes among admissions for acute ischemic stroke receiving systemic thrombolysis. Int J Stroke. 2019;14(1):48–52. https://doi.org/10.1177/1747493018778135.

    Article  PubMed  Google Scholar 

  12. Selvik HA, Naess H, Kvistad CE. Intravenous thrombolysis in ischemic stroke patients with active cancer. Front Neurol. 2018;9:811. https://doi.org/10.3389/fneur.2018.00811.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418. https://doi.org/10.1161/str.0000000000000211.

    Article  PubMed  Google Scholar 

  14. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581–641. https://doi.org/10.1161/str.0000000000000086.

    Article  PubMed  Google Scholar 

  15. Tsivgoulis G, Safouris A, Alexandrov AV. Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions. Expert Opin Drug Saf. 2015;14(6):845–64. https://doi.org/10.1517/14740338.2015.1032242.

    Article  CAS  PubMed  Google Scholar 

  16. Merkler AE, Marcus JR, Gupta A, Kishore SA, Leifer D, Patsalides A, et al. Endovascular therapy for acute stroke in patients with cancer. Neurohospitalist. 2014;4(3):133–5. https://doi.org/10.1177/1941874413520509.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, et al. European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE). Eur Stroke J. 2019;4(1):6–12. https://doi.org/10.1177/2396987319832140.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Etgen T, Steinich I, Gsottschneider L. Thrombolysis for ischemic stroke in patients with brain tumors. J Stroke Cerebrovasc Dis. 2014;23(2):361–6. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.05.004.

    Article  PubMed  Google Scholar 

  19. Fugate JE, Rabinstein AA. Absolute and relative contraindications to IV rt-PA for acute ischemic stroke. Neurohospitalist. 2015;5(3):110–21. https://doi.org/10.1177/1941874415578532.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Murthy SB, Moradiya Y, Shah S, Shastri A, Bershad EM, Suarez JI. In-hospital outcomes of thrombolysis for acute ischemic stroke in patients with primary brain tumors. J Clin Neurosci. 2015;22(3):474–8. https://doi.org/10.1016/j.jocn.2014.09.016.

    Article  PubMed  Google Scholar 

  21. Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, et al. Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology. 2014;83(1):26–33. https://doi.org/10.1212/wnl.0000000000000539.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cutting S, Wettengel M, Conners JJ, Ouyang B, Busl K. Three-month outcomes are poor in stroke patients with cancer despite acute stroke treatment. J Stroke Cerebrovasc Dis. 2017;26(4):809–15. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.021.

    Article  PubMed  Google Scholar 

  23. Carrier M, Prandoni P. Controversies in the management of cancer-associated thrombosis. Expert Rev Hematol. 2017;10(1):15–22. https://doi.org/10.1080/17474086.2017.1257935.

    Article  CAS  PubMed  Google Scholar 

  24. Li A, Manohar PM, Garcia DA, Lyman GH, Steuten LM. Cost effectiveness analysis of direct oral anticoagulant (Doac) versus dalteparin for the treatment of cancer associated thrombosis (cat) in the United States. Thromb Res. 2019;180:37–42. https://doi.org/10.1016/j.thromres.2019.05.012.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sarigiannidis I. Cost-effectiveness analysis of different anticoagulant classes in cancer associated thrombosis (Cat). A differential approach accounting thrombotic and bleeding risk, applied in the Greek health care environment. 2019.

  26. Sobieraj DM, Baker WL, Smith E, Sasiela K, Trexler SE, Kim O, et al. Anticoagulation for the treatment of cancer-associated thrombosis: a systematic review and network meta-analysis of randomized trials. Clin Appl Thromb Hemost. 2018;1076029618800792:182S–7S. https://doi.org/10.1177/1076029618800792.

    Article  CAS  Google Scholar 

  27. Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R, et al. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med. 2006;119(12):1062–72. https://doi.org/10.1016/j.amjmed.2006.02.022.

    Article  CAS  PubMed  Google Scholar 

  28. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146–53. https://doi.org/10.1056/NEJMoa025313.

    Article  CAS  PubMed  Google Scholar 

  29. Ross JA, Miller MM, Rojas Hernandez CM. Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: a retrospective analysis. Thromb Res. 2017;150:86–9. https://doi.org/10.1016/j.thromres.2016.12.016.

    Article  CAS  PubMed  Google Scholar 

  30. Seaman S, Nelson A, Noble S. Cancer-associated thrombosis, low-molecular-weight heparin, and the patient experience: a qualitative study. Patient Prefer Adherence. 2014;8:453–61. https://doi.org/10.2147/ppa.s58595.

    Article  PubMed  PubMed Central  Google Scholar 

  31. van Es N, Coppens M, Schulman S, Middeldorp S, Buller HR. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood. 2014;124(12):1968–75. https://doi.org/10.1182/blood-2014-04-571232.

    Article  CAS  PubMed  Google Scholar 

  32. Posch F, Konigsbrugge O, Zielinski C, Pabinger I, Ay C. Treatment of venous thromboembolism in patients with cancer: a network meta-analysis comparing efficacy and safety of anticoagulants. Thromb Res. 2015;136(3):582–9. https://doi.org/10.1016/j.thromres.2015.07.011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. • Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615–24. https://doi.org/10.1056/NEJMoa1711948. Describes the results of the HOKUSAI-VTE trial on cancer patients, where edoxaban was compared to dalteparin. Both substances were equally effective in preventing VTE recurrence and the survival rates were also similar. However, bleeding complications were more frequent in the edoxaban group, especially in cases of GI malignancies.

    Article  CAS  PubMed  Google Scholar 

  34. • Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36(20):2017–23. https://doi.org/10.1200/jco.2018.78.8034. Presents the results of the SELECT-D trial on cancer patients, where rivaroxaban was compared to dalteparin. Rivaroxaban was more effective in preventing VTE recurrence, and the survival and major bleeding rates were similar. Clinically relevant, minor bleedings were more frequent with rivaroxaban, especially in patients with GI malignancies.

    Article  CAS  PubMed  Google Scholar 

  35. Mantha S, Laube E, Miao Y, Sarasohn DM, Parameswaran R, Stefanik S, et al. Safe and effective use of rivaroxaban for treatment of cancer-associated venous thromboembolic disease: a prospective cohort study. J Thromb Thrombolysis. 2017;43(2):166–71. https://doi.org/10.1007/s11239-016-1429-1.

    Article  CAS  PubMed  Google Scholar 

  36. Prins MH, Lensing AW, Brighton TA, Lyons RM, Rehm J, Trajanovic M, et al. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. Lancet Haematol. 2014;1(1):e37–46. https://doi.org/10.1016/s2352-3026(14)70018-3.

    Article  PubMed  Google Scholar 

  37. Khorana AA, Soff GA, Kakkar AK, Vadhan-Raj S, Riess H, Wun T, et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med. 2019;380(8):720–8. https://doi.org/10.1056/NEJMoa1814630.

    Article  CAS  PubMed  Google Scholar 

  38. Cohen AT, Maraveyas A, Beyer-Westendorf J, Lee AYY, Mantovani LG, Bach M. COSIMO - patients with active cancer changing to rivaroxaban for the treatment and prevention of recurrent venous thromboembolism: a non-interventional study. Thromb J. 2018;16:21. https://doi.org/10.1186/s12959-018-0176-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. • McBane RD 2nd, Wysokinski WE, Le-Rademacher JG, Zemla T, Ashrani A, Tafur A, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: The ADAM VTE trial. J Thromb Haemost. 2019. https://doi.org/10.1111/jth.14662. Describes the results of the ADAM VTE trial on cancer patients, comparing apixaban and dalteparin. Apixaban was more effective in preventing VTE recurrence, with both treatment groups presenting similar survival and bleeding rates.

  40. Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med. 2019;380(8):711–9. https://doi.org/10.1056/NEJMoa1814468.

    Article  CAS  PubMed  Google Scholar 

  41. Agnelli G, Becattini C, Bauersachs R, Brenner B, Campanini M, Cohen A, et al. Apixaban versus dalteparin for the treatment of acute venous thromboembolism in patients with Cancer: the Caravaggio Study. Thromb Haemost. 2018;118(9):1668–78. https://doi.org/10.1055/s-0038-1668523.

    Article  PubMed  Google Scholar 

  42. Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest. 2015;147(2):475–83. https://doi.org/10.1378/chest.14-0402.

    Article  PubMed  Google Scholar 

  43. Li A, Garcia DA, Lyman GH, Carrier M. Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): a systematic review and meta-analysis. Thromb Res. 2019;173:158–63. https://doi.org/10.1016/j.thromres.2018.02.144.

    Article  CAS  PubMed  Google Scholar 

  44. Franco-Moreno A, Cabezon-Gutierrez L, Palka-Kotlowsa M, Villamayor-Delgado M, Garcia-Navarro M. Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update. J Thromb Thrombolysis. 2019;47(3):409–19. https://doi.org/10.1007/s11239-018-1783-2.

    Article  CAS  PubMed  Google Scholar 

  45. Francis CW, Kessler CM, Goldhaber SZ, Kovacs MJ, Monreal M, Huisman MV, et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN Study. J Thromb Haemost. 2015;13(6):1028–35. https://doi.org/10.1111/jth.12923.

    Article  CAS  PubMed  Google Scholar 

  46. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–52. https://doi.org/10.1016/j.chest.2015.11.026.

    Article  PubMed  Google Scholar 

  47. Carrier M, Khorana AA, Zwicker J, Noble S, Lee AY. Management of challenging cases of patients with cancer-associated thrombosis including recurrent thrombosis and bleeding: guidance from the SSC of the ISTH. J Thromb Haemost. 2013;11(9):1760–5. https://doi.org/10.1111/jth.12338.

    Article  CAS  PubMed  Google Scholar 

  48. Khorana AA, Carrier M, Garcia DA, Lee AY. Guidance for the prevention and treatment of cancer-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):81–91. https://doi.org/10.1007/s11239-015-1313-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Park DY, Khorana AA. Risks and benefits of anticoagulation in cancer and noncancer patients. Semin Thromb Hemost. 2019;45(6):629–37. https://doi.org/10.1055/s-0039-1693474.

    Article  PubMed  Google Scholar 

  50. Imberti D, Cimminiello C, Di Nisio M, Marietta M, Polo Friz H, Ageno W. Antithrombotic therapy for venous thromboembolism in patients with cancer: expert guidance. Expert Opin Pharmacother. 2018;19(11):1177–85. https://doi.org/10.1080/14656566.2018.1496238.

    Article  CAS  PubMed  Google Scholar 

  51. • Carrier M, Blais N, Crowther M, Kavan P, Le Gal G, Moodley O, et al. Treatment algorithm in cancer-associated thrombosis: Canadian expert consensus. Curr Oncol. 2018;25(5):329–37. https://doi.org/10.3747/co.25.4266. The Canadian Expert consensus guidelines, where the use of DOACs is recommended and a therapeutic algorithm for the selection of an anticoagulation agent is presented.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Khorana AA, Noble S, Lee AYY, Soff G, Meyer G, O'Connell C, et al. Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16(9):1891–4. https://doi.org/10.1111/jth.14219.

    Article  CAS  PubMed  Google Scholar 

  53. Napolitano M, Saccullo G, Malato A, Sprini D, Ageno W, Imberti D, et al. Optimal duration of low molecular weight heparin for the treatment of cancer-related deep vein thrombosis: the Cancer-DACUS Study. J Clin Oncol. 2014;32(32):3607–12. https://doi.org/10.1200/jco.2013.51.7433.

    Article  CAS  PubMed  Google Scholar 

  54. van der Hulle T, den Exter PL, van den Hoven P, van der Hoeven JJ, van der Meer FJ, Eikenboom J, et al. Cohort study on the management of cancer-associated venous thromboembolism aimed at the safety of stopping anticoagulant therapy in patients cured of cancer. Chest. 2016;149(5):1245–51. https://doi.org/10.1016/j.chest.2015.10.069.

    Article  PubMed  Google Scholar 

  55. Jara-Palomares L, Solier-Lopez A, Elias-Hernandez T, Asensio-Cruz M, Blasco-Esquivias I, Marin-Barrera L, et al. Tinzaparin in cancer associated thrombosis beyond 6months: TiCAT study. Thromb Res. 2017;157:90–6. https://doi.org/10.1016/j.thromres.2017.07.004.

    Article  CAS  PubMed  Google Scholar 

  56. Elalamy I, Mahe I, Ageno W, Meyer G. Long-term treatment of cancer-associated thrombosis: the choice of the optimal anticoagulant. J Thromb Haemost. 2017;15(5):848–57. https://doi.org/10.1111/jth.13659.

    Article  CAS  PubMed  Google Scholar 

  57. Song AB, Rosovsky RP, Connors JM, Al-Samkari H. Direct oral anticoagulants for treatment and prevention of venous thromboembolism in cancer patients. Vasc Health Risk Manag. 2019;15:175–86. https://doi.org/10.2147/vhrm.s132556.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Connolly SJ, Crowther M, Eikelboom JW, Gibson CM, Curnutte JT, Lawrence JH, et al. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019;380(14):1326–35. https://doi.org/10.1056/NEJMoa1814051.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Heo YA. Andexanet alfa: first global approval. Drugs. 2018;78(10):1049–55. https://doi.org/10.1007/s40265-018-0940-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Favresse J, Hardy M, van Dievoet MA, Sennesael AL, Douxfils J, Samama CM, et al. Andexanet alfa for the reversal of factor Xa inhibitors. Expert Opin Biol Ther. 2019;19(5):387–97. https://doi.org/10.1080/14712598.2019.1599355.

    Article  CAS  PubMed  Google Scholar 

  61. Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373(6):511–20. https://doi.org/10.1056/NEJMoa1502000.

    Article  CAS  PubMed  Google Scholar 

  62. Ansell JE, Bakhru SH, Laulicht BE, Steiner SS, Grosso M, Brown K, et al. Use of PER977 to reverse the anticoagulant effect of edoxaban. N Engl J Med. 2014;371(22):2141–2. https://doi.org/10.1056/NEJMc1411800.

    Article  PubMed  Google Scholar 

  63. Silvis SM, Hiltunen S, Lindgren E, Jood K, Zuurbier SM, Middeldorp S, et al. Cancer and risk of cerebral venous thrombosis: a case-control study. J Thromb Haemost. 2018;16(1):90–5. https://doi.org/10.1111/jth.13903.

    Article  CAS  PubMed  Google Scholar 

  64. Raper DM, Zukas AM, Schiff D, Asthagiri AR. Geographically remote cerebral venous sinus thrombosis in patients with intracranial tumors. World Neurosurg. 2017;98:555–62. https://doi.org/10.1016/j.wneu.2016.11.084.

    Article  PubMed  Google Scholar 

  65. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158–92. https://doi.org/10.1161/STR.0b013e31820a8364.

    Article  PubMed  Google Scholar 

  66. Ferro JM, Bousser MG, Canhao P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203–13. https://doi.org/10.1111/ene.13381.

    Article  CAS  PubMed  Google Scholar 

  67. Avanali R, Gopalakrishnan MS, Devi BI, Bhat DI, Shukla DP, Shanbhag NC. Role of decompressive craniectomy in the management of cerebral venous sinus thrombosis. Front Neurol. 2019;10:511. https://doi.org/10.3389/fneur.2019.00511.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM. Leptomeningeal metastases in the MRI era. Neurology. 2010;74(18):1449–54. https://doi.org/10.1212/WNL.0b013e3181dc1a69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Remon J, Le Rhun E, Besse B. Leptomeningeal carcinomatosis in non-small cell lung cancer patients: a continuing challenge in the personalized treatment era. Cancer Treat Rev. 2017;53:128–37. https://doi.org/10.1016/j.ctrv.2016.12.006.

    Article  CAS  PubMed  Google Scholar 

  70. Chamberlain M, Soffietti R, Raizer J, Ruda R, Brandsma D, Boogerd W, et al. Leptomeningeal metastasis: a Response Assessment in Neuro-Oncology critical review of endpoints and response criteria of published randomized clinical trials. Neuro-Oncology. 2014;16(9):1176–85. https://doi.org/10.1093/neuonc/nou089.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Wang N, Bertalan MS, Brastianos PK. Leptomeningeal metastasis from systemic cancer: review and update on management. Cancer. 2018;124(1):21–35. https://doi.org/10.1002/cncr.30911.

    Article  PubMed  Google Scholar 

  72. Frick J, Ritch PS, Hansen RM, Anderson T. Successful treatment of meningeal leukemia using systemic high-dose cytosine arabinoside. J Clin Oncol. 1984;2(5):365–8. https://doi.org/10.1200/jco.1984.2.5.365.

    Article  CAS  PubMed  Google Scholar 

  73. Lassman AB, Abrey LE, Shah GD, Panageas KS, Begemann M, Malkin MG, et al. Systemic high-dose intravenous methotrexate for central nervous system metastases. J Neuro-Oncol. 2006;78(3):255–60. https://doi.org/10.1007/s11060-005-9044-6.

    Article  CAS  Google Scholar 

  74. Oechsle K, Lange-Brock V, Kruell A, Bokemeyer C, de Wit M. Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis. J Cancer Res Clin Oncol. 2010;136(11):1729–35. https://doi.org/10.1007/s00432-010-0831-x.

    Article  PubMed  Google Scholar 

  75. Brastianos P, Prakadan S, Alvarez-Breckenridge C, Lee E, Tolaney S, Nayak L, et al. Phase II study of pembrolizumab in leptomeningeal carcinomatosis. J Clin Oncol. 2018;36:2007. https://doi.org/10.1200/JCO.2018.36.15_suppl.2007.

    Article  Google Scholar 

  76. Boogerd W, van den Bent MJ, Koehler PJ, Heimans JJ, van der Sande JJ, Aaronson NK, et al. The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study. Eur J Cancer. 2004;40(18):2726–33. https://doi.org/10.1016/j.ejca.2004.08.012.

    Article  CAS  PubMed  Google Scholar 

  77. Cochereau D, Da Costa S, Le Maignan C, Gauthier H, Cochereau J, Espie M, et al. Intrathecal methotrexate in breast cancer meningeal carcinomatosis - experience with a new administration schedule. Bull Cancer. 2016;103(5):444–54. https://doi.org/10.1016/j.bulcan.2016.02.002.

    Article  PubMed  Google Scholar 

  78. Comte A, Jdid W, Guilhaume MN, Kriegel I, Piperno-Neumann S, Dieras V, et al. Survival of breast cancer patients with meningeal carcinomatosis treated by intrathecal thiotepa. J Neuro-Oncol. 2013;115(3):445–52. https://doi.org/10.1007/s11060-013-1244-x.

    Article  CAS  Google Scholar 

  79. Olmos-Jimenez R, Espuny-Miro A, Diaz-Carrasco MS, Fernandez-Varon E, Valderrey-Pulido M, Carceles-Rodriguez C. Stability of four standardized preparations of methotrexate, cytarabine, and hydrocortisone for intrathecal use. J Oncol Pharm Pract. 2016;22(5):659–65. https://doi.org/10.1177/1078155215600905.

    Article  CAS  PubMed  Google Scholar 

  80. Souchon R, Feyer P, Thomssen C, Fehm T, Diel I, Nitz U, et al. Clinical recommendations of DEGRO and AGO on preferred standard palliative radiotherapy of bone and cerebral metastases, metastatic spinal cord compression, and leptomeningeal carcinomatosis in breast cancer. Breast Care (Basel). 2010;5(6):401–7. https://doi.org/10.1159/000322661.

    Article  Google Scholar 

  81. Kramer K, Kushner B, Modak S, Pandit-Taskar N, Tomlinson U, Wolden S, et al. A curative approach to central nervous system metastases of neuroblastoma. J Clin Oncol. 2017;35:10545. https://doi.org/10.1200/JCO.2017.35.15_suppl.10545.

    Article  Google Scholar 

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Author notes

  1. Athina-Maria Aloizou and Vasileios Siokas contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Stroke Unit, University Hospital of Larissa, University of Thessaly, 41221, Larissa, Greece

    Athina-Maria Aloizou MD, Vasileios Siokas MD, PhD, Metaxia Dastamani MD, MSc, Maria Sokratous MD, MSc, Georgia Xiromerisiou MD, PhD, Georgios M. Hadjigeorgiou MD, PhD & Efthimios Dardiotis MD, PhD

  2. Department of Microbiology, University Hospital of Larissa, University of Thessaly, Larissa, Greece

    Alexios-Fotios A. Mentis MD, MPH, PgCert

  3. Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece

    Alexios-Fotios A. Mentis MD, MPH, PgCert

  4. Department of Neurology, School of Medicine, University of Crete, 71003, Heraklion, Greece

    Panayiotis D. Mitsias MD, PhD

  5. Department of Neurology & Comprehensive Stroke Center, Henry Ford Hospital, Detroit, MI, USA

    Panayiotis D. Mitsias MD, PhD

  6. Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus

    Georgios M. Hadjigeorgiou MD, PhD

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  1. Athina-Maria Aloizou MD
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Correspondence to Efthimios Dardiotis MD, PhD.

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Aloizou, AM., Siokas, V., Mentis, AF.A. et al. Advancements in the Treatment of Cerebrovascular Complications of Cancer. Curr Treat Options Neurol 22, 16 (2020). https://doi.org/10.1007/s11940-020-00624-6

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